丹参酮ⅡA磺酸钠注射液联合卡维地洛对急性冠脉综合征患者的疗效及近期结局的影响

Effects of sodium tanshinone IIA sulfonate injection combined with carvedilol in patients with acute coronary syndrome

目的探讨丹参酮ⅡA磺酸钠注射液联合卡维地洛对急性冠脉综合征(ACS)患者的疗效及近期结局的影响。方法选取82例ACS患者为研究对象,以随机数字表法分为对照组、研究组,每组各41例。对照组采用常规治疗联合卡维地洛,12.5 mg/次,2次/d。研究组在对照组的基础上另给予丹参酮ⅡA磺酸钠注射液,40~80 mg/次,1次/d。两组均持续治疗8周后评价效果,两组自治疗开始起随访12个月。采集治疗前(治疗前1 d)、治疗后(持续治疗8周后)的外周静脉血,采用彩色多普勒超声诊断仪检测左室射血分数(LVEF)、左室舒张末期内径(LVEDD)和左室舒张末期容积(LVEDV)。采用化学分析法检测血清乳酸脱氢酶(LDH)水平,采用全自动生化分析仪检测血清肌酸激酶(CK)水平,采用免疫比浊法检测血清心肌肌钙蛋白I(cTnI)水平。采用ELISA法检测血清脂蛋白相关磷脂酶A2(Lp-PLA2)和纤溶酶原激活物抑制物-1(PAI-1)水平。采用压力传感器式全自动血液流变仪检测全血高剪切粘度、全血低剪切粘度和血浆粘度。对比两组心功能、心肌损伤、炎症因子、血流动力学情况,记录药物安全性,统计随访期间心脏不良事件发生情况。结果两组治疗后的LVEF均高于治疗前,LVEDD、LVEDV均低于治疗前(均P<0.05),研究组治疗后的LVEF高于对照组,而LVEDD、LVEDV均低于对照组(均P<0.05)。两组治疗后的CK、cTnI、LDH均低于治疗前(均P<0.05),研究组治疗后的CK、cTnI、LDH均低于对照组(均P<0.05)。两组治疗后Lp-PLA2、PAI-1均低于治疗前(均P<0.05),研究组治疗后的Lp-PLA2、PAI-1均低于对照组(均P<0.05)。两组治疗后全血高切黏度、全血低切黏度、血浆黏度均低于治疗前(均P<0.05),研究组治疗后的全血高切黏度、全血低切黏度、血浆黏度均低于对照组(均P<0.05)。两组总不良反应发生率对比差异无统计学意义(P>0.05)。研究组总心脏不良事件发生率低于对照组(P<0.05)。结论丹参酮ⅡA磺酸钠注射液联合卡维地洛治疗ACS患者可明显改善其心功能、减轻心肌损伤、降低炎症因子水平、改善血液流变学功能及近期结局,且安全性良好。

Objective To investigate the efficacy of sodium tanshinone IIa sulfonate injection combined with carvedilol in the patients with acute coronary synfrome(ACS).Methods 82 patients with ACS undergoing conventional treatment including antiplantiplatelet drugs,nitrate medicine,and statins were randomly divided into 2 equal groups:control group given carvedilol 12.5 mg bid for 8 weeks,and research group administerd with intravenous drip of sodium IIA sulfonate 40~80 mg once a dayin addition for 8 weeks.Both groups were evaluated after 8 weeks of continuous treatment and followed up for 12 months from the beginning of treatment.Peripheral venous blood samples were collected before treatment and after continuous treatment for 8 weeks.Doppler ultrasonic diagnosis apparatus was used to detect the left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)and left ventricular end diastolic volume(LVEDV).Colorimetry was used to detect the serum level of lactate dehydrogenase(LDH).Automatic biochemical analyzer was used to detect the serum creatine kinase(CK)level.Immunoturbidimetry was used to detect the serum level of cardiac troponin I(cTnI).The serum levels of lipoprotein-associated phospholipase A2(Lp-PLA2 and plasmin stock activator inhibitor-1(PAI-1)were detected by ELISA.Sensor type automatic blood rheometer was used to detect the whole blood high shear viscosity,whole blood low shear viscosity,and plasma viscosity.Cardiac function,myocardial injury,inflammatory factors,and hemodynamics were compared between the two groups before and after treatment.Drug safety was recorded,and the incidence of adverse cardiac events during the follow-up period was counted.Results The LVEF levels after treatment in both groups were significantly higher than those before treatment,while the LVEDD and LVEDV levels after treatment in both groups were significantly lower than those before treatment(all P<0.05).The LVEF level after treatment in the research group was significantly higher than that in the control group,while the LVEDD and LVEDV levels after treatment in the research group were both significantly lower than those in the control group(both P<0.05).The levels of CK,cTnI,and LDH after treatment in the two groups were all significantly lower than those before treatment(all P<0.05),and the CK,cTnI,and LDH levels after treatment in the research group were all significantly lower than those in the control group(all P<0.05).The Lp-PLA2 and PAI-1 after treatment in the 2 groups were both significantly lower than those before treatment(all P<0.05),and the Lp-PLA2 and PAI-1 levels after treatment in the research group were both significantly lower than those in the control group(both P<0.05).The whole blood high shear viscosity,whole blood low shear viscosity and plasma viscosity after treatment in the two groups were both significantly lower than those before treatment(both P<0.05).The whole blood high shear viscosity,whole blood low shear viscosity,and plasma viscosity after treatment in the research group were all significantly lower than those in the control group(all P<0.05).There was no significant difference in the incidence of total adverse reactions between the two groups(P>0.05).The incidence of total cardiac adverse events in the research group was lower than that in the control group(P<0.05).Conclusion Tanshinone IIA sodium sulfonate injection combined with carvedilol in the treatment of ACS patients can significantly improve their cardiac function,reduce myocardial injury,reduce the level of inflammatory factors,improve hemorheological function and short-term outcomes,and has good safety.