重组人组织型纤溶酶原激酶衍生物治疗对ACS患者冠脉微循环的影响

The effects of recombinant human tissue type plasminogen kinase derivative on coronary artery microcirculation in patients with acute coronary syndrome

目的探讨重组人组织型纤溶酶原激酶衍生物(RT-PA)治疗急性冠脉综合征(ACS)对患者冠脉微循环的影响。方法选取ACS患者100例,依据随机数字表法分为RT-PA组和常规组,每组50例,常规组给予常规基础治疗,RT-PA组在此基础上给予RT-PA(瑞替普酶)治疗,比较2组冠脉微循环阻力系数(IMR)、内皮功能[内皮素(ET)、一氧化氮(NO)]、心脏血流动力学[心输出量(CO)、心脏指数(CI)、射血分数(EF)]、心肌损伤[肌酸激酶同工酶(CKMB)、肌钙蛋白T(cTnT)、肌钙蛋白I(cTnI)]、不良反应、不良心脏事件。结果 RT-PA组和常规组治疗后CO、CI、EF、NO明显高于治疗前,RT-PA组治疗后CO、CI、EF、NO明显高于常规组,RT-PA组和常规组治疗后ET、IMR、CKMB、cTnT、cTnI明显低于治疗前,RT-PA组治疗后ET、IMR、CKMB、cTnT、cTnI明显低于常规组,差异有统计学意义(P<0.05);RT-PA组和常规组不良反应发生率比较,差异无统计学意义(P>0.05);随访6个月,RT-PA组不良心脏事件发生率明显低于常规组,差异有统计学意义(P<0.05)。结论 RT-PA治疗可有效改善ACS患者冠脉微循环、内皮功能、心脏血流动力学,有利于减少患者的心肌损伤、不良心脏事件,且具有良好的安全性。

Objective To investgate the effects of recombinant human tissue type plasminogen kinase derivative(RT-PA)on coronary artery microcirculation in patients with acute coronary syndrome(ACS).Methods One hundred patients with ACS who were treated in our hospital from October 2014 to October 2017 were enrolled in the study.According to the random digital table method,these patients were divided into RT-PA group and routine treatment group,with 50 cases in each group.The patients in routine treatment group were given routine treatment,howevere,the patients in RT-PA group,on this basis of routine treatment group,were treated by RT-PA(reteplase).After treatment the resistance coefficient of coronary microcirculation(IMR),endothelial function[endothelin(ET),oxygen nitrogen(NO)],cardiac hemodynamics[cardiac output(CO),heart index(CI),ejection fraction(EF)],myocardial injury[creatine kinase isoenzyme(CKMB),troponin T(cTnT),troponin I(cTnI)],adverse reactions and adverse cardiac events were observed and compared between the two groups.Results After treatment the CO,CI,EF,NO were significantly increased in both groups,as compared with those before treatment,moreover,which in RT-PA group were significantly higher than those in routine treatment group.After treatment the ET,IMR,CKMB,cTnT,cTnI were significantly decreased in both groups,as compared with those before treatment,moreover,which in RT-PA group were significantly lower than those in routine treatment group(P<0.05).There was no significant difference in the incidence rate of adverse reactions between the two grousp(P<0.05).After 6-month follow-up,the incidence rate of adverse cardiac event in RT-PA group was significantly lower than that in routine treatment group(P<0.05).Conclusion RT-PA therapy can effectively improve the coronary artery microcirculation,endothelial function and cardiac hemodynamics in patients with ACS,it is beneficial to relieve the myocardial injury and adverse cardiac events of the patients,with good safety,therefor,it is worthy of further clinical promotion.