不同疗程远程缺血后适应对急性ST段抬高型心肌梗死介入治疗术后疗效的研究

Effects of different courses of remote ischemic postconditioning on patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention

目的探讨远程缺血后适应(RIPostC)对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)术后临床疗效,明确其合理的实施方案。方法收集2018年1月—2021年9月于青岛市第八人民医院心血管内科住院,第一诊断为STEMI,并行急诊PCI术的患者341例,随机入对照组(87例)、即刻RIPostC组(90例)、短程RIPostC组(83例)、长程RIPostC组(81例)。观察各组患者术后30 d以及半年心血管死亡率、因心衰再住院率和再次心梗率;检测术后肌酸激酶同工酶(CKMB)、肌钙蛋白T(TNT)峰值,术后次日、1周、30 d以及半年血清氨基末端脑钠肽前体(NT-proBNP)、基质金属蛋白酶(MMP)-9和组织抑制因子(TIMP)-1水平、左室舒张末期容积(LVEDD)以及左室射血分数(LVEF)。结果长程RIPostC组术后半年心血管死亡率较对照组、即刻及短程RIPostC组降低(P<0.05);短程、长程RIPostC组术后30 d、半年因心衰再住院率较对照组、即刻RIPostC组降低(P<0.05),长程RIPostC组术后半年因心衰再住院率低于短程RIPostC组(P<0.05);四组患者术后CKMB、TNT峰值以及次日、1周NT-proBNP、LVEDD和LVEF水平无统计学差异(P>0.05);短程、长程RIPostC组较对照组、即刻RIPostC组在术后30 d、半年NT-proBNP、LVEDD降低,LVEF升高(P<0.05);长程RIPostC组较短程RIPostC组术后半年NT-proBNP、MMP-9、LVEDD降低,TIMP-1、LVEF升高(P<0.05)。结论给予STEMI患者RIPostC至术后30 d可改善患者心功能,减少因心衰再住院率,将疗程延长至半年可抑制心肌重构,降低心血管死亡率,进一步提高疗效。

Objective To explore the clinical efficacy of RIPostC for STEMI patients after PCI and clarify its reasonable strategy.Methods A total of 341 patients with STEMI receiving the emergency PCI and hospitalized in department of cardiovascular of Qingdao Eighth People's Hospital from January 2018 to September 2021 were collected.Patients were randomly enrolled into the controlled group(87cases),instant RIPostC group(90cases),short-term RIPostC group(83cases)and long-term RIPostC group(81cases).The cardiovascular mortality rate,rehospitalization rate due to heart failure and recurrent myocardial infarction rate were observed 30 days and 6 months after PCI.The peak levels of CKMB and TNT after PCI were detected.The levels of NT-proBNP,MMP-9,TIMP-1,LVEDD and LVEF were detected on the next day,1 week,30 days and 6 months after PCI.Results The cardiovascular mortality of the longterm RIPostC group was lower than that of the controlled,instant and short-term RIPostC groups 6 months after PCI(P<0.05).The rehospitalization rate of the short and long-term RIPostC groups was lower than that of the controlled and instant RIPostC groups 30 days and 6 months after PCI(P<0.05).The rehospitalization rate of the long-term RIPostC group 6 months after PCI was lower than that of the short-term RIPostC group(P<0.05).Compared with the controlled and instant RIPostC groups,the levels of NT-proBNP and LVEDD decreased and the level of LVEF increased in the short and long-term RIPostC groups 30 days and 6 months after PCI(P<0.05).Compared with the short-term RIPostC group,the levels of NT-proBNP,MMP-9 and LVEDD is lower,while the levels of TIMP-1 and LVEF were higher in the long-term RIPostC group 6 months after PCI(P<0.05).Conclusion RIPostC implemented to patients with STEMI up to 30 days after PCI can improve cardiac function and reduce rehospitalization due to heart failure.When the course is prolonged to 6 months,it can inhibit the cardiac remodeling and lower the cardiovascular mortality.