摘要
目的 探讨替罗非班对急性心肌梗死直接PCI患者术后疗效的作用及Wnt/β连环蛋白(β-catenin)表达的影响。方法 前瞻性纳入郑州大学第二附属医院就诊的急性ST段抬高型心肌梗死并行急诊PCI的患者230例,通过随机数字表法分为研究组和对照组各115例。2组患者均在术前服用负荷量双联抗血小板药物;研究组于术中冠状动脉内注射替罗非班,随后持续静脉泵入替罗非班,持续24 h。3个月后比较2组患者炎性因子、免疫相关指标、血小板功能及外周血单个核细胞Wnt/β-catenin信号通路表达水平,统计不良反应发生情况。结果 治疗后2组患者的肌钙蛋白I、肌酸激酶同工酶、高敏C反应蛋白、免疫球蛋白(Ig)A、IgG、IgM、血小板黏附率、血小板聚集率均显著降低,P选择素水平显著升高(P<0.01),研究组显著低于对照组,差异有统计学意义(P<0.01)。治疗后2组Wnt/β-catenin表达水平较治疗前均明显降低(P<0.01),研究组Wnt/β-catenin表达水平显著低于对照组(1.27±0.63 vs 1.83±0.74/1.35±0.32 vs 2.26±0.45,P<0.01)。2组患者在治疗期间均未出现严重的不良反应。研究组不良反应总发生率显著低于对照组(8.70%vs 20.87%,χ;=7.765,P=0.009)。结论 替罗非班对急性心肌梗死直接PCI患者术后疗效确切,可有效调节患者血清炎性因子水平,改善机体免疫功能,抑制血小板功能,安全性较高。
Objective To study the impact of tirofiban on curative effect and Wnt/β-catenin expression in acute myocardial infarction(AMI) patients after direct PCI.Methods Two hundred and thirty acute STEMI patients who underwent emergency PCI in our hospital were randomly divided into study group(n=115) and control group(n=115).The patients in two groups were treated with double antiplatelet drugs before operation.Tirofiban was injected into coronary artery of the patients in study group during operation followed by continuous intravenous pumping of tirofiban for 24 h.The inflammatory factors, immune-related indicators, platelet function and Wnt/β-catenin expression level in peripheral mononuclear cells were compared between the two groups and the incidence of adverse reactions in two groups was recorded after 3 months of treatment.Results The serum levels of troponin 1,creatine kinase isoenzyme, hs-CRP,IgA,IgG,IgM,platelet adhesion rate and aggregation rate were significantly lower in two groups after treatment(P<0.01).The serum level of P-selectin was significantly higher in study group than in control group after treatment(P<0.01).The Wnt/β-catenin expression level was significantly lower in two groups after treatment(P<0.01) and in study group than in control group after treatment(1.27±0.63 vs 1.83±0.74/1.35±0.32 vs 2.26±0.45,P<0.01).No serious adverse reactions occurred in two groups of patients during the treatment.The total incidence of adverse reactions was significantly lower in study group than in control group(8.70% vs 20.87%,χ^(2)=7.765,P=0.009).Conclusion Tirofiban can effectively regulate the serum level of inflammatory factors, improve the immunologic function and inhibit the platelet function in AMI patients with a high safety.
作者
朱银川
杨雁华
汤建民
Zhu Yinchuan;Yang Yanhua;Tang Jianmin(Department of Cardiology,Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China)
出处
《中华老年心脑血管病杂志》
北大核心
2022年第5期476-479,共4页
Chinese Journal of Geriatric Heart,Brain and Vessel Diseases
基金
河南省医学科技攻关计划(LHGJ20210386)。
