摘要
目的经皮冠状动脉成形术(percutaneous coronary intervention,PCI)和支架植入术是急性心肌梗死(acute myocardial infraction,AMI)早期治疗的重要方法,经循证医学证据证实有较好的近期和远期效果。本研究观察外源性脂联素降低2型糖尿病合并急性ST段抬高型心肌梗死(ST-elevation acute myocardial infarction,STEMI)患者在急诊PCI治疗中无复流发生效果及其可能机制。方法选择2015-03-01-2018-01-31恩施土家族苗族自治州中心医院诊断为2型糖尿病合并STEMI的80例患者为研究对象,按照组间基本特征均衡可比的原则分为对照组和观察组,每组40例,符合急诊PCI治疗原则。对照组术中应用腺苷冠脉内注射和替罗非班微量泵静脉泵入,观察组联合外源性脂联素冠脉内注射,对比治疗效果。结果观察组慢血流和无复流发生率为5.0%,低于对照组的22.5%,差异有统计学意义,χ2=5.530,P=0.024。观察组介入操作时间为(2.2±0.7)min,低于对照组的(5.6±1.8)min,t=12.939,P=0.006。观察组术中血清肌酸激酶同工酶(creatine kinase isoenzymes,CK-MB)升高程度为0.8±0.2,低于对照组的1.1±0.3,t=3.659,P=0.031;肌钙蛋白I(cardiac troponin I,cTnI)升高程度为0.7±0.2,低于对照组的0.9±0.2,t=3.458,P=0.035。治疗后,观察组血清白介素-6(interleukin-6,IL-6)水平为(85.2±20.3)mmol/L,低于对照组的(114.7±31.2)mmol/L,t=6.534,P<0.001;肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平为(38.5±6.2)mmol/L,低于对照组的(47.9±8.7)mmol/L,t=6.128,P<0.001;内皮素-1(endothelin-1,ET-1)水平为(88.5±35.4)μmol/L,低于对照组的(107.8±56.2)μmol/L,t=5.852,P=0.012;血管内皮黏附分子-1(vascular cell adhesion molecular-1,VCAM-1)水平为(112.3±58.9)μmol/L,低于对照组的(167.5±65.4)μmol/L,t=6.052,P=0.007;bax/bcl-2比值为0.38±0.17,低于对照组的0.53±0.23,t=4.658,P=0.025。术后随访6个月,观察组主要心脏不良事件发生率为7.5%,低于对照组的25.0%,χ2=4.709,P=0.030。结论外源性脂联素可以进一步降低2型糖尿病合并STEMI患者急诊PCI治疗中无复流的发生,与减轻心肌和内皮细胞损伤,抑制炎症反应和细胞凋亡有关,对改善远期临床疗效有明显效果。
OBJECTIVE Percutaneous coronary intervention(PCI)and stent implantation are important methods for the early treatment of acute myocardial infraction(AMI).Evidence-based medical evidence has proven to have good shortterm and long-term effects.The study aimed to observe the effect of exogenous adiponectin on type 2 diabetes mellitus combined with acute ST-segment elevation myocardial infarction(STEMI)in patients without regurgitation during emergency PCI and its possible mechanism.METHODS From March 31,2015 to January 31,2018,a total of 80 patients diagnosed with type 2 diabetes and STEMI in Central Hospital of Enshi Tujia and Miao Autonomous Prefecture were selected as the research subjects.They were divided into the control group and the observation group according to the principle of balanced and comparable basic characteristics between the groups.In line with the principle of emergency PCI treatment,the control group received intra-adenosine intraperitoneal injection and tirofiban micropump intravenous injection,and the observation group combined with exogenous adiponectin intracoronary injection.RESULTS The incidence of slow blood flow and no reflow in the observation group was 5.0%,which was lower than 22.5%in the control group.The difference was statistically significant,χ~2=5.530,P=0.024.The intervention time in the observation group was(2.2±0.7)min,which was lower than that in the control group(5.6±1.8)min,t=12.939,P=0.006.The increase of serum creatine kinase isoenzymes(CK-MB)in the observation group was 0.8±0.2,which was lower than that in the control group 1.1±0.3,t=3.659,P=0.031;muscle The elevation of cardiac troponin I(cTnI)was 0.7±0.2,which was lower than that of the control group(0.9±0.2),t=3.458,P=0.035.After treatment,the serum interleukin(IL-6)levels in the observation group was(85.2±20.3)mmol/L,which was lower than that in the control group(114.7±31.2)mmol/L,t=6.534,P<0.001;The level of tumor necrosis factor-α(TNF-α)was(38.5±6.2)mmol/L,which was lower than the control group’s(47.9±8.7)mmol/L,t=6.128,P<0.001;endothelium Endothelin-1(ET-1)level was(88.5±35.4)μmol/L,which was lower than that of the control group(107.8±56.2)μmol/L,t=5.852,P=0.012;vascular endothelial adhesion molecule-The level of vascular cell adhesion molecular-1(VCAM-1)was(112.3±58.9)μmol/L,which was lower than that of the control group(167.5±65.4)μmol/L,t=6.052,P=0.007;bax/bcl-2 was(0.38±0.17),which was lower than that of the control group 0.53±0.23,t=4.658,P=0.025.After 6 months of follow-up,the incidence of major cardiac adverse events in the observation group was 7.5%,which was lower than 25.0%in the control group,χ~2=4.709,P=0.030.CONCLUSION Exogenous adiponectin can further reduce the occurrence of no regurgitation in the emergency PCI treatment of patients with type 2 diabetes and STEMI,and it is related to reducing myocardial and endothelial cell damage,inhibiting inflammatory response and apoptosis,and it has obvious improvement on long-term clinical efficacy effect.
作者
何柯
苏可
杨胜祥
HE Ke;SU Ke;YANG Sheng-xiang(Department of Cardiology,Central Hospital of Enshi Tujia and Miao Autonomous Prefecture,Enshi 445000,P.R.China)
出处
《社区医学杂志》
2020年第16期1129-1133,共5页
Journal Of Community Medicine
关键词
外源性脂联素
2型糖尿病
急性ST段抬高型心肌梗死
无复流
炎症反应
exogenous adiponectin
type 2diabetes
acute ST-segment elevation myocardial infarction
no reflow
inflammatory response
