梗死前心绞痛对ST段抬高型心肌梗死的心脏保护作用

Cardioprotective Effect of Pre-infarction Angina with ST Segment Elevation Myocardial Infarction

目的探讨梗死前心绞痛(PIA)对急性ST段抬高型心肌梗死(STEMI)患者的心脏保护作用。方法选择2020年1至12月在宁夏医科大学总医院行经皮冠状动脉介入治疗(PCI)的STEMI患者323例,将其分为梗死前心绞痛组(PIA组)163例和对照组160例,检测两组患者心肌肌钙蛋白Ⅰ、白细胞(WBC)、C反应蛋白(CRP)、N端B型利钠肽原(NT-proBNP)、心肌梗死面积、心功能、冠状动脉病变、TIMI血流等指标,记录院内主要不良心血管事件(MACE)的发生情况。结果PIA组心肌肌钙蛋白Ⅰ、WBC、CRP、NT-proBNP、心肌梗死面积、术后无复流及慢血流情况发生均低于对照组(P均<0.05);左室射血分数(LVEF值)高于对照组(P<0.05);住院期间MACE发生率低于对照组(P<0.05)。结论PIA通过减少心肌损伤及心肌梗死面积、减轻炎性反应、改善心脏功能、降低无复流及慢血流发生率等起到心脏保护作用,从而改善STEMI患者临床预后。

Objective To investigate the cardioprotective effect of pre-infarction angina(PIA)on the patients with acute ST segment elevation myocardial infarction(STEMI).Methods From January 2020 to December 2020,323 patients with STEMI who underwent emergency percutaneous coronary intervention(PCI)in the General Hospital of Ningxia Medical University were divided into the PIA group(163 cases)and the control group(160 cases).The cardiac troponinⅠ,white blood cell,C-reactive protein,N-terminal pro-B-type natriuretic peptide(NT-proBNP),myocardial infarction area,cardiac function,coronary artery lesion and TIMI blood flow were detected in all objects.The major adverse cardiovascular events(MACE)in hospital were recorded in the two groups.Results The mean values of cTnⅠ,WBC,CRP,NT-proBNP,myocardial infarction area and no reflow/slow blood flow incidence in PIA group were significantly lower than those in the control group(P all<0.05).The LVEF value in the PIA group was significantly higher than that in the control group(P<0.05).The incidence of MACE during hospitalization was significantly lower than that in the control group(P<0.05).Conclusion PIA plays a cardioprotective role by reducing myocardial injury and myocardial infarction size,decreasing inflammatory reaction,improving left ventricular function and reducing the incidence of no reflow/slow blood flow,thereby improving the clinical prognosis of STEMI patients.