磷酸肌酸钠对STEMI患者急诊PCI术后的心肌保护作用及对血清PTX-3和OPN表达的影响

The protective effect of creatine phosphate sodium on the myocardium in STEMI patients after emergency PCI and the influence on the expression of PTX-3 and OPN

目的探讨磷酸肌酸钠(creatine phosphate sodium,CP)对ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入(PCI)术后的心肌保护作用及对血清正五聚蛋白-3(pentraxin 3,PTX-3)、骨桥蛋白(OPN)表达的影响。方法选取邢台市第三医院2017年1月1日至2020年6月30日收治的132例急诊行PCI术的STEMI患者为研究对象,随机分为观察组和对照组(每组各66例)。对照组采用常规方法治疗,观察组在对照组基础上加用CP治疗。比较两组患者的心肌损伤标志物[磷酸肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)]、心功能指标[左室舒张末容积指数(LVEDVI)、心室收缩末容积指数(LVESVI)、左室射血分数(LVEF)、左室质量指数(LVMI)及N端脑钠肽前体(NT-proBNP)]、超敏C-反应蛋白(hs-CRP)及OPN、PTX-3水平;并记录两组患者术后30 d的主要心血管不良事件(MACE)和出血事件的发生情况。结果术后30 d,观察组LVESVI、LVEDVI、LVMI及NT-proBNP水平较治疗前和对照组均明显下降(P<0.05),LVEF水平明显升高(P<0.05),且两组患者治疗后CK-MB、cTnT及hs-CRP水平明显下降(P<0.05),观察组下降程度优于对照组(P<0.05);术后30 d,两组患者PTX-3和OPN水平明显下降(P<0.05),且观察组下降程度优于对照组(P<0.05)。两组患者在术后30 d内均未出现心源性死亡,观察组MACE总发生率4.55%(3/66)低于对照组16.67%(11/66),出血事件发生率9.09%(6/66)低于对照组24.24%(16/66),且差异有统计学意义(P<0.05)。结论CP可降低STEMI患者急诊PCI术后血清PTX-3和OPN表达水平,得以改善心肌能量代谢和炎症反应,进而发挥心肌细胞保护作用及改善患者心功能,减少术后MACE发生风险。

Objective To investigate the protective effect of creatine phosphate sodium on the myocardium of patients with STEMI after emergency PCI and the influence on the expression of pentraxin 3(PTX-3)and osteopontin(OPN).Methods A total of 132 STEMI patients with emergency PCI admitted to Xingtai Third Hospital from January 1,2017 to June 30,2020 were selected as the research objects,and were randomly divided into an observation group and a control group with 66 cases in each group.The control group was treated with conventional methods,and the observation group was treated with creatine phosphate sodium on the basis of the control group;The myocardial injury markers(CK-MB,cTnT),cardiac function indexes(LVEDVI,LVESVI,LVEF,NT-proBNP),inflammatory factor hs-CRP,OPN,PTX-3 level were compared;The major adverse cardiac events(MACE)and bleeding events in the two groups were recorded 30 days after surgery.Results The levels of LVESVI,LVEDVI,LVMI,and NT-proBNP in the observation group were significantly lower 30 days after operation than before the treament and in the control group(P<0.05),and the LVEF level was significantly increased(P<0.05).In addition,the levels of CK-MB,cTnT,and hs-CRP in the two groups decreased significantly after the treatment(P<0.05),and the decrease in the observation group was more obvious than that in the control group(P<0.05).30 days after operation,the levels of PTX-3 and OPN in the two groups decreased significantly(P<0.05),and the decrease in the observation group was more obvious than that in the control group(P<0.05).There was no cardiac death in the two groups within 30 days after surgery.The total incidence of MACE in the observation group[4.55%(3/66)]was lower than that in the control group[16.67%(11/66)],and the incidence of bleeding events[9.09%(6/66).]in the observation group was lower than that in the control group[24.24%(16/66)],the difference was statistically significant(P<0.05).Conclusions Creatine phosphate sodium can reduce the serum PTX-3 and OPN expression levels after PCI in STEMI patients,and improve myocardial energy metabolism and inflammation,thereby exerting a protective effect on myocardial cells and improving the cardiac function of patients,reducing the risk of MACE after surgery.