摘要
目的探讨冠状动脉内应用重组人尿激酶原(rhPro-UK)联合替罗非班对老年急性ST段抬高型心肌梗死(STEMI)患者PCI术后的治疗效果,以及其对心肌指标和炎症指标的影响。方法选取2021年1月至2022年12月海口市第三人民医院收治的112例老年STEMI患者作为研究对象,按照随机数字表法将其分为观察组和对照组,每组56例。比较两组PCI术前和术后即刻的心肌梗死溶栓试验(TIMI)血流分级、校正TIMI血流计帧数(cTFC)、TIMI心肌灌注分级(TMPG),记录ST段回落率(STR)。比较两组PCI术前和术后1个月血清N末端脑钠肽前体(NT-proBNP)水平,左心室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)及左心室射血分数(LVEF)。比较两组PCI术前和术后1周血清白细胞介素(IL)-1β、IL-6及C-反应蛋白(CRP)水平。记录并比较患者术中及术后24 h内出血事件、两组住院期间及PCI术后3个月内主要不良心血管事件(MACE)发生情况。结果两组术前TIMI血流分级、TMPG、cTFC比较,差异均无统计学意义(P>0.05)。观察组术后TIMI血流分级、TMPG分级、STR>50%均明显高于对照组,而观察组术后cTFC低于对照组,差异均有统计学意义(P<0.05)。观察组和对照组术后TIMI血流分级及TMPG明显高于对照组,cTFC明显低于对照组,差异均有统计学意义(P<0.05)。观察组术后1个月NT-proBNP、LVEDD与LVESD均明显低于对照组,LVEF高于对照组,差异均有统计学意义(P<0.05)。与同组术前比较,观察组和对照组术后1个月NT-proBNP、LVEDD及LVESD均明显降低,LVEF均明显升高,差异均有统计学意义(P<0.05)。观察组与对照组总出血事件发生率比较,差异无统计学意义(χ^(2)=0.101,P=0.751)。观察组与对照组术后3个月内总MACE发生率比较,差异无统计学意义(χ^(2)=1.734,P=0.188)。观察组术后1周IL-1β、IL-6、CRP水平均明显低于对照组,差异均有统计学意义(P<0.05)。与同组术前比较,观察组和对照组术后IL-1β、IL-6、CRP水平均明显降低,差异均有统计学意义(P<0.05)。结论老年STEMI患者进行PCI过程中,冠状动脉内应用rhPro-UK联合替罗非班可有效改善心肌血流灌注及心功能,减轻炎症反应,且不增加出血风险及MACE发生率。
Objective To investigate the therapeutic effect of recombinant human prourokinase(rhPro-UK)combined with tirofiban in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)after PCI and the influence on myocardial indexes and inflammatory indexes.Methods A total of 112 elderly patients with STEMI admitted to Haikou Third People′s Hospital from January 2021 to December 2022 were selected as the research objects,and they were divided into observation group and control group according to the random number table method,with 56 cases in each group.The thrombolysis in myocardial infarction(TIMI)flow grade,corrected TIMI flow meter frame number(cTFC),TIMI myocardial perfusion grade(TMPG)and ST segment resolution rate(STR)were compared between the two groups before and immediately after PCI.The levels of serum N-terminal pro-brain natriuretic peptide(NT-proBNP),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD)and left ventricular ejection fraction(LVEF)were compared between the two groups before and 1 month after PCI.The levels of serum interleukin(IL)-1β,IL-6 and C-reactive protein(CRP)were compared between the two groups before and 1 week after PCI.Bleeding events during operation and within 24 hours after operation,and major adverse cardiovascular events(MACE)during hospitalization and within 3 months after PCI were recorded and compared between the two groups.Results There were no significant difference in preoperative TIMI flow grade,TMPG,and cTFC between the two groups(P>0.05).The postoperative TIMI blood flow grade,TMPG grade and STR>50%in the observation group were significantly higher than those in the control group,while the postoperative cTFC in the observation group was lower than that in the control group,and the differences were statistically significant(P<0.05).The TIMI blood flow grade and TMPG in the observation group and the control group were significantly higher than those in the control group,and the cTFC was significantly lower than that in the control group,and the differences were statistically significant(P<0.05).One month after operation,NT-proBNP,LVEDD and LVESD in the observation group were significantly lower than those in the control group,LVEF was higher than that in the control group,and the differences were statistically significant(P<0.05).The levels of NT-proBNP,LVEDD and LVESD in the observation group and the control group were significantly lower than those before operation,and the LVEF was significantly higher at 1 month after operation(P<0.05).There was no significant difference in incidence of total bleeding events between the observation group and the control group(χ^(2)=0.101,P=0.751).There was no significant difference in the incidence of total MACE between the observation group and the control group within 3 months after operation(χ^(2)=1.734,P=0.188).The levels of IL-1β,IL-6 and CRP in the observation group were significantly lower than those in the control group at 1 week after operation,and the differences were statistically significant(P<0.05).The levels of IL-1β,IL-6 and CRP in the observation group and the control group were significantly lower than those before operation,and the differences were statistically significant(P<0.05).Conclusion Intracoronary application of rhPro-UK combined with tirofiban during PCI in elderly patients with STEMI can effectively improve myocardial perfusion and cardiac function,reduce inflammatory response,and does not increase the risk of bleeding and the incidence of MACE.
作者
庄文辉
徐志鹏
王华
吕厚宽
程炎炎
ZHUANG Wenhui;XU Zhipeng;WANG Hua;LYU Houkuan;CHENG Yanyan(Department of Pharmacy,Haikou Third People′s Hospital,Haikou,Hainan 571100,China;Department of Cardiology,Haikou Third People′s Hospital,Haikou,Hainan 571100,China)
出处
《检验医学与临床》
CAS
2024年第13期1933-1938,共6页
Laboratory Medicine and Clinic
关键词
急性ST段抬高型心肌梗死
老年人
重组人尿激酶原
替罗非班
经皮冠状动脉介入
acute ST-segment elevation myocardial infarction
the elderly
recombinant human prourokinase
tirofiban
percutaneous coronary intervention was performed
作者简介
庄文辉,男,主管药师,主要从事临床心血管疾病药物方面的研究。
