麝香保心丸联合人脑利钠肽对急性ST段抬高型心肌梗死患者的心肌保护作用及对动脉血流参数、ST2和IL-33的影响

Effects of Shexiang Baoxin Pills Combined with Human Brain Natriuretic Peptide on Myocardial Protection, Arterial Blood Flow Parameters, ST2 and IL-33 in Patients with Acute ST-Segment Elevation Myocardial Infarction

目的:探讨麝香保心丸联合人脑利钠肽对急性ST段抬高型心肌梗死患者的心肌保护作用,以及对动脉血流参数、可溶性生长刺激表达基因2(ST2)和白细胞介素33(IL-33)的影响。方法:该前瞻性研究的研究时间为2021年3月至2023年3月,受试对象为105例急性ST段抬高型心肌梗死患者,共脱落5例,最后完成疗程并有完整记录的为100例。将100例患者采用随机数字表法分为研究组和对照组,每组50例。两组患者入院后均采取常规吸氧、心电监护等措施,立即建立静脉通路,并行经皮冠状动脉介入治疗;对照组患者采用注射人脑利钠肽进行治疗,研究组患者在对照组的基础上口服麝香保心丸,两组患者均连续治疗14 d。比较研究组与对照组患者治疗前后胸痛胸闷、心悸、气短、疲倦乏力、面肢浮肿和气喘等中医症状积分并比较疗效,比较研究组与对照组患者冠状动脉再通率,治疗前后心肌标志物水平、动脉血流参数以及血清ST2、IL-33、一氧化氮(NO)和内皮素-1(ET-1)水平变化。结果:治疗后,研究组患者胸痛胸闷、心悸、气短、疲倦乏力、面肢浮肿和气喘等各项中医症状积分较对照组更低,差异均有统计学意义(P<0.05)。研究组患者的治疗总有效率为96.00%(48/50),显著高于对照组的84.00%(42/50),差异有统计学意义(P<0.05)。治疗后,研究组患者血清N末端B型利钠肽前体、乳酸脱氢酶、心肌肌钙蛋白T和肌酸磷酸激酶含量较对照组更低;研究组患者冠状动脉再通率分级情况显著优于对照组;研究组患者左心室射血分数、左心室高峰充盈率、收缩期血流速度峰值、舒张期血流速度峰值和冠状动脉血流速度储备较对照组更高,左心室舒张末期内径较对照组更低;研究组患者血清ST2、IL-33和ET-1水平较对照组更低,血清NO水平较对照组更高,上述差异均有统计学意义(P<0.05)。结论:麝香保心丸联合人脑利钠肽对急性ST段抬高型心肌梗死患者的疗效较好,有助于保护心肌细胞,改善动脉血流循环,其心肌保护作用机制可能与减少ST2和IL-33的表达以及减轻血管损伤有关。

OBJECTIVE:To probe into the effects of Shexiang Baoxin pills combined with human brain natriuretic peptide on myocardial protection,arterial blood flow parameters,soluble growth stimulation expression gene 2(ST-2)and interleukin 33(IL-33)in patients with acute ST-segment elevation myocardial infarction.METHODS:The research subjects of this prospective study were 105 patients with acute ST-segment elevation myocardial infarction,a total of 5 cases were dislodged,and 100 cases had finally completed the course of treatment with complete records;the research period was from Mar.2021 to Mar.2023;the 100 patients were divided into research group and control group via random number table method,with 50 cases in each group.After admission,both groups were given routinely oxygen uptake and cardiac monitoring,the intravenous access was immediately established and percutaneous coronary intervention was carried out,the control group was treated with human brain natriuretic peptide for injection,and the research group was orally administered with Shexiang Baoxin pills based on the control group,both groups were treated continuously for 14 days.The TCM symptom scores of chest pain and chest tightness,palpitations,short of breath,tiredness and weakness,face and limbs swelling,asthma were compared between research group and control group before and after treatment,and the efficacy was compared,the coronary artery recirculation rates,the cardiac marker levels,arterial blood flow parameters,changes of serum ST2,IL-33,nitric oxide(NO)and endothelin-1(ET-1)levels before and after treatment were compared between research group and control group.RESULTS:After treatment,the research group had lower TCM symptom scores of chest pain and chest tightness,palpitation,short of breath,tiredness and weakness,face and limbs swelling,and asthma,with statistically significant differences(P<0.05).The total effective rate of the research group was 96.00%(48/50),which was significantly higher than 84.00%(42/50)of the control group,with statistically significant difference(P<0.05).After treatment,the serum N-terminal B-type natriuretic peptide precursor,lactate dehydrogenase,cardiac troponin T and creatine phosphokinase levels were lower in the research group compared with the control group;the coronary recirculation rate grading of the research group was significantly better than that of the control group;the left ventricular ejection fraction,left ventricular peak filling rate,peak systolic blood flow velocity,peak diastolic blood flow velocity and coronary blood flow velocity reserve of the research group were higher than those of the control group,and the left ventricular end-diastolic dimension of the research group was lower than that of the control group;the serum ST2,IL-33 and ET-1 levels of the research group were lower than those of the control group,and the serum NO level of the observation group was higher than that of the control group,the differences were statistically significant(P<0.05).CONCLUSIONS:The efficacy of Shexiang Baoxin pills combined with human brain natriuretic peptide in the treatment of acute ST-segment elevation myocardial infarction is remarkable,which helps to protect cardiomyocytes and improve arterial blood circulation,the mechanism of its myocardial protection effect may be associated with reducing ST2 and IL-33 expression as well as relieving vascular injury.