不同治疗方法对冠心病患者心率变异性血清KLK1 TIMP-1水平及近期预后的影响研究

Study on the Effects of Different Treatments on Heart Rate Variability Serum KLK1 and TIMP-1 Levels and Short-Term Prognosis in Patients with Coronary Artery Disease

目的:探究国产雷帕霉素药物洗脱支架和紫杉醇药物洗脱球囊对冠心病患者心率变异性、血清激肽释放酶1(KLK1)、基质金属蛋白酶组织抑制因子-1(TIMP-1)水平及近期预后的影响。方法:回顾2019年11月至2021年5月间在我院接受经皮冠状动脉介入治疗的105例冠心病患者资料,根据治疗方式不同将其分为观察组(56例,使用国产雷帕霉素药物洗脱支架)和对照组(49例,使用国产紫杉醇药物洗脱球囊)。比较两组术前、术后1周、随访1年时的心率变异性相关指标[5min内正常窦性RR间期标准差(SDNN)、5min内正常RR间期均值标准差(SDANN)、相邻NN间期之间差大于50ms数占比(pNN50)],术前、术后1周时的KLK1、TIMP-1、内皮素-1(ET-1)、一氧化氮(NO)水平,随访1年的近期预后[血管再狭窄、血管再血栓、主要心血管不良事件(MACE)]。结果:两组SDNN、SDANN、pNN50重复测量方差分析时间比较差异有统计学意义(P<0.017),均随术后时间延长呈上升趋势;两组患者手术前后血清KLK1、TIMP-1、NO及血浆ET-1水平差值绝对值比较差异有统计学意义(P<0.05),观察组变化幅度大于对照组;随访1年时,观察组血管再狭窄发生率低于对照组,差异有统计学意义(P<0.05),两组血管再血栓发生率、MACE发生率比较差异无统计学意义(P>0.05)。结论:国产雷帕霉素药物洗脱支架可有效调节冠心病患者心率变异性,对改善血清KLK1、TIMP-1水平有积极作用,有助于保护、修复患者内皮功能,降低支架内狭窄风险,获得良好近期预后。

Objective:To investigate the effects of domestic rapamycin drug-eluting stent and paclitaxel drug-eluting balloon on heart rate variability,levels of serum Kallikrein 1(KLK1)and tissue inhibitor of matrix metalloproteinase-1(TIMP-1)and short-term prognosis in patients with coronary heart disease.Methods:The data of 105 patients with coronary artery disease who received percutaneous coronary intervention in the hospital from November 2019 to May 2021 were reviewed,and they were divided into the observation group(56 cases,using domestic rapamycin drug-eluting stent)and the control group(49 cases,treated with domestic paclitaxel drug-eluting balloon)according to different stents used.The heart rate variability-related indicators[standard deviation of normal sinus RR interval within 5 min(SDNN),standard deviation of the 5-minute average RR intervals(SDANN),percent of differences between adjacent NN intervals greater than 50 ms(pNN50)]before surgery,at 1 week after surgery and at 1 year follow-up,levels of KLK1,TIMP-1,endothelin-1(ET-1)and nitric oxide(NO)before surgery and at 1 week after surgery as well as short-term prognosis[vascular re-stenosis,vascular re-thrombosis,major adverse cardiovascular events(MACE)]at 1 year of follow-up were compared between the two groups.Results:There were statistical differences in the SDNN,SDANN and pNN50 in repeated measures analysis of variance between the two groups form the aspect of time-point effect(P<0.017),and the above three indicators showed upward trends with the prolongation of postoperative time.The absolute values of differences of serum KLK1,TIMP-1,NO and plasma ET-1 before and after surgery revealed statistically significant differences between the two groups(P<0.05),and the changes in the observation group were greater than those in the control group.At 1 year of follow-up,the incidence rate of vascular re-stenosis in the observation group was lower than that in the control group(P<0.05),but there were no statistically significant differences in the incidence rates of vascular re-thrombosis and MACE between the two groups(P>0.05).Conclusion:Domestic rapamycin drug-eluting stent can effectively regulate heart rate variability in patients with coronary artery disease,and it has a positive effect on improving serum KLK1 and TIMP-1 levels,and can help protect and repair the endothelial function,reduce the risk of stent stenosis,and achieve the good short-term prognosis.