尼可地尔对急性心肌梗死患者PPCI后无复流的干预研究

The Study of Effects of Nicorandil on No-Reflow After PPCIin Patients with Acute Myocardial Infarction

目的探讨尼可地尔对急性ST段抬高型心肌梗死(STEMI)患者无复流(NR)的影响及可能的作用机制。方法选取2021年4月至2022年4月就诊于解放军第九六〇医院60例急诊行直接经皮冠状动脉介入治疗(PPCI)的STIMI患者,随机将患者分为尼可地尔组和对照组,每组各30例。尼可地尔组PPCI术中冠脉内注射尼可地尔4mg,对照组冠脉内注射等容量生理盐水。观察术后TIMI血流分级、校正TIMI血流帧数(cTFC)、静息灌注总积分(SRS)、左室射血分数(LVEF)、心搏量(SV)、左室短轴缩短率(LVFS)等指标,并检测术前及术后血浆miR-221-3p/miR-222-3p的表达水平。结果尼可地尔组术后梗死相关血管cTFC显著少于对照组(P<0.05)。对照组NR发生率33.3%,尼可地尔组NR发生率明显降低至10%(P<0.05)。与对照组比较,尼可地尔组术后7d的SRS≥10分患者减少(P<0.05),LVEF、SV、LVFS水平均显著升高(P<0.05)。两组术前miR-221-3p/miR-222-3p表达差异无统计学意义,术后7d尼可地尔组miR-221-3p/miR-222-3p表达明显低于对照组(P<0.05),且miR-221-3p/miR-222-3p表达水平与cTFC呈显著正相关(P<0.01)。结论STEMI患者行PPCI术中冠脉注射尼可地尔可降低术后NR的发生率,改善左室收缩功能,其作用可能与降低血浆miR-221-3p/miR-222-3p水平有关。

Objective To investigate the effect and potential mechanism of nicorandil on no-reflow(NR)in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods The current trial selected 60 patients with STIMI who underwent direct primary percutaneous coronary intervention(PPCI)in the Emergency Department of the 960th Hospital of the People’s Liberation Army from April,2021 to April,2022,and we randomly divided these patients into a nicorandil group and a control group,30 cases in each group.The nicorandil group received intracoronary injection of 4mg nicorandil during PPCI,and the control group received intracoronary injection of equal volume of normal saline.Post-operative TIMI blood flow classification,corrected TIMI frame count(cTFC),summedrest score(SRS),left ventricular ejection fraction(LVEF),stroke volume(SV),left ventricular fractional shortening(LVFS)and other indicators were collected,and expression levels of miR-221-3p/miR-222-3p before and after surgery were detected.Results cTFC of post-operative infarction-related vessels in the nicorandil group was significantly lower than that in the control group(P<0.05).The incidence of NR in the control group was 33.3%,and the incidence of NR in the nicorandil group was significantly reduced to 10%(P<0.05).Compared with the control group,the number of patients with SRS≥10 points in the nicorandil group decreased 7 days after surgery(P<0.05),and levels of LVEF,SV,and LVFS were significantly increased(P<0.05).There was no significant difference in the expression of miR-221-3p/miR-222-3p between the two groups before surgery(P>0.05),and the expression of miR-221-3p/miR-222-3p in the nicorandil group was significantly lower than that in the control group at 7 days after surgery(P<0.05).Furthermore,the expression level of miR-221-3p/miR-222-3p was significantly positively correlated with cTFC(P<0.01).Conclusion Coronary injection of nicorandil during PPCI in STEMI patients can reduce the incidence of post-operative NR and improve left ventricular systolic function,which could be related to the reduction of plasma miR-221-3p/miR-222-3p levels.