艾司洛尔对急性心肌梗死PCI患者炎性因子及血清miR-29a、GDF-15的影响

Effects of Esmolol on inflammatory factors and serum miR-29a and GDF-15 in patients with acute anterior ST-segment elevation myocardial infarction after PCI

目的 探究艾司洛尔对急性前壁ST段抬高型心肌梗死经皮冠状动脉介入(PCI)术患者的治疗效果,以及对患者炎性因子及血清微小核糖核酸-29a(miR-29a)、生长分化因子-15(GDF-15)的影响。方法 前瞻性选取2021年4月至2023年6月于新乡市中心医院行PCI术治疗的120例急性前壁ST段抬高型心肌梗死患者。按照随机数字表法分为艾司洛尔组和对照组,每组60例。对照组予以常规治疗,艾司洛尔组在常规治疗基础上予以艾司洛尔注射液治疗24 h,比较两组安全性、心功能指标、炎性因子水平、心肌酶学、miR-29a、GDF-15的差异。结果 两组在症状性低血压、症状性心动过缓以及恶性心律失常发生率方面比较差异没有统计学意义(P>0.05)。两组治疗1周后左心室射血分数与治疗前比较升高,左心室收缩末期容积指数、左心室舒张末期内径和BNP与治疗前比较降低(P<0.05);且艾司洛尔组治疗1周后左心室射血分数、左心室收缩末期容积指数、左心室舒张末期内径和BNP的变化优于对照组(P<0.05)。两组治疗1周后CRP、髓过氧化物酶、IL-6、CK-MB、cTnI与治疗前比较均降低(P<0.05);且艾司洛尔组治疗1周后CRP、髓过氧化物酶、IL-6、cTnI的变化均优于对照组(P<0.05)。重复测量分析结果显示,两组治疗3 d、1周miR-29a、GDF-15与治疗前相比均降低(P<0.05),且治疗1周miR-29a、GDF-15低于治疗3 d(P<0.05)。艾司洛尔组治疗3 d、治疗1周miR-29a、GDF-15优于对照组(P<0.05)。结论 艾司洛尔应用于行PCI术的急性前壁ST段抬高型心肌梗死患者可有效改善心功能,降低炎性因子水平,减少心肌损伤,并降低血清miR-29a、GDF-15水平,同时安全性较好。

Objective To explore the therapeutic effect of Esmolol in patients with acute anterior ST-segment elevation myo-cardial infarction after percutaneous coronary intervention(PCI),as well as the effects on inflammatory factors and serum miR-29a and GDF-15.Methods A total of 120 patients with acute anterior ST-segment elevation myocardial infarction who underwent PCI in Xinxiang Central Hospital from April 2021 to June 2023 were prospectively selected as the study objects,and were divided into the study group(60 cases)and the control group(60 cases)according to random number table method.The control group was given con-ventional treatment,and the study group was combined with Esmolol injection on the basis of the control group for 24 hours.The safety,cardiac function indexes,inflammatory factor levels,myocardial en-zyme indexes,miR-29a and GDF-15 were compared between the two groups.Results There was no significant difference in the inci-dence of symptomatic hypotension,symptomatic bradycardia and ma-lignant arrhythmia between the two groups(P>0.05).After 1 week of treatment,left ventricular ejection fraction increased compared with before treatment,while left ventricular end-systolic volume index,left ventricular end-diastolic diameter and BNP decreased compared with before treatment(P<0.05).After 1 week of treatment,the changes of left ventricular ejection fraction,left ventricular end-systolic vol-ume index,left ventricular end-diastolic inner diameter and BNP in the study group were better than those in the control group(P<0.05).After 1 week of treatment,CRP,myeloperoxidase,IL-6,CK-MB and cTnI were all decreased compared with those before treatment(P<0.05).After 1 week of treatment,CRP,myeloperoxidase,L-6 and cTnI in the study group were lower than those in the control group(P<0.05).The results of repeated measurement ANOVA showed that miR-29a and GDF-15 were decreased in both groups after treat-ment compared with before treatment,and miR-29a and GDF-15 were lower after 1 week than after 3 days of treatment(P<0.05).But miR-29a and GDF-15 in the study group were superior to those in the control group after 3 days and 1 week of treatment(P<0.05).Conclusion Esmolol has a good therapeutic effect on patients with acute anterior ST-segment elevation myocardial infarction after PCI,which can effectively improve cardiac function,reduce inflammatory factors,alleviate myocardial injury,regulate serum miR-29a and GDF-15 levels,and does not increase the risk of adverse reactions.