摘要
目的 探讨替格瑞洛在急性心肌梗死(AMI)多支病变患者经皮冠状动脉介入治疗(PCI)术后的效果。方法 选取2021年2月~2023年2月于河北省沧州中西医结合医院就诊的AMI多支病变患者156例,按照随机数字表法分为常规组78例、研究组78例。常规组PCI术前给予氯吡格雷,研究组PCI术前给予替格瑞洛。比较两组心功能指标[左心室舒张末期容积指数(LVEDVI)、左心室射血分数(LVEF)、左心室收缩末期容积指数(LVESVI)]、心肌微循环指标[右冠状动脉帧数(RCA CTFC)、左前降支帧数(LAD CTFC)、左回旋支帧数(LCX CTFC)]、心肌损伤指标[肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(CTn-I)]、血小板聚集率、Wnt/β-连环蛋白(Wnt/β-catenin)通路相关基因(Wnt mRNA、β-catenin mRNA)、炎症指标及术后6个月不良心血管事件(MACE)发生率。结果 研究组术后30 d的LVEDVI、LVESVI低于常规组[(55.34±5.24)ml/m^(2)比(65.79±6.32)ml/m^(2)、(32.63±2.74)ml/m^(2)比(36.22±3.38)ml/m^(2)]LVEF高于常规组[(57.32±4.25)%比(52.65±3.49)%],差异有统计学意义(P<0.05);术后7 d研究组RCA CTFC、LAD CTFC、LCX CTFC均低于常规组[(19.11±3.03)帧比(24.35±3.56)帧、(18.75±2.14)帧比(22.74±3.03)帧、(16.52±2.06)帧比(21.14±3.18)帧],差异有统计学意义(P<0.05);研究组术后24 h CK-MB、CTn-I水平均低于常规组[(32.16±4.17)U/L比(45.23±5.39)U/L、(5.13±1.08)ng/ml比(7.68±1.23)ng/ml],差异有统计学意义(P<0.05);研究组术后24 h、30 d血小板聚集率低于常规组(P<0.05);研究组术后30 d Wnt、β-catenin、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平低于常规组[(1.03±0.30)比(1.59±0.35)、(2.06±0.37)比(1.12±0.33)、(124.36±18.63)ng/ml比(164.79±24.78)ng/ml、(20.28±3.32)ng/ml比(37.26±4.27)ng/ml],差异有统计学意义(P<0.05);研究组术后6个月MACE发生率低于常规组(2.56%比11.54%,P<0.05)。结论 相较于氯吡格雷,AMI多支病变患者PCI术前给予替格瑞洛治疗的血小板抑制效果更为显著,可改善心功能、心肌微循环,减轻心肌损伤,抑制炎症反应,减少PCI术后MACE发生,其机制可能与抑制Wnt/β-catenin通路活化有关。
Objective To investigate the effect of ticagrelor on patients with multivessel coronary artery disease(CAD)after percutaneous coronary intervention(PCI)for acute myocardial infarction(AMI).Methods A total of 156 patients with AMI and multi-vessel lesions were selected from February 2021 to February 2023,and were divided into the conventional group(78 cases)and study group(78 cases)according to random number table method.The conventional group was given clopidogrel before PCI,and the study group was given ticagrelor before PCI.The cardiac function indexes [left ventricular end-diastolic volume index(LVEDVI),left ventricular ejection fraction(LVEF),left ventricular end-systolic volume index(LVESVI)],myocardial microcirculation indexes[right coronary artery frame number(RCA CTFC),left anterior descending branch frame number(LAD CTFC),left circumflex branch frame number(LCX CTFC),myocardial damage indicators[creatine kinase isoenzyme(CK-MB),cardiac troponin I(CTn-I)],platelet aggregation rate,Wnt/β-catenin pathway related genes(Wnt mRNA,β-catenin mRNA),inflammatory markers and the incidence of MACE 6 months after surgery were compared between the two groups.Results The LVEDVI and LVESVI of the study group were lower than those of the conventional group at 30 days after the surgery[(55.34±5.24)ml/m^(2) vs.(65.79±6.32)ml/m^(2),(32.63±2.74)ml/m^(2) vs.(36.22±3.38)ml/m^(2)],while the LVEF was higher than that of the conventional group[(57.32±4.25)%vs.(52.65±3.49)%,with statistically significant differences(P<0.05)].At 7 days after the surgery,the RCA CTFC,LAD CTFC and LCX CTFC in the study group were lower than those of the conventional group[(19.11±3.03)frames vs.(24.35±3.56)frames,(18.75±2.14)frames vs.(22.74±3.03)frames,(16.52±2.06)frames vs.(21.14±3.18)frames],with statistically significant differences(P<0.05).The levels of CK-MB and CTn-I in the study group were lower than those in the conventional group 24 hours after the surgery[(32.16±4.17)U/L vs.(45.23±5.39)U/L,(5.13±1.08)ng/ml vs.(7.68±1.23)ng/ml],with statistically significant differences(P<0.05).The platelet aggregation rate in the study group was lower than that in the conventional group at 24 hours and 30 days after the surgery(P<0.05).The levels of Wnt,β-catenin,interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)in the study group were lower than those in the conventional group at 30 days after the surgery[(1.03±0.30)vs.(1.59±0.35),(2.06±0.37)vs.(1.12±0.33),(124.36±18.63)ng/ml vs.(164.79±24.78)ng/ml,and(20.28±3.32)ng/ml vs.(37.26±4.27)ng/ml],with statistically significant differences(P<0.05).The incidence of MACE in the study group was lower than that in the conventional group 6 months after the surgery(2.56%vs.11.54%,P<0.05).Conclusion Compared with clopidogrel,ticagrelor therapy before PCI has more significant platelet inhibition effect in AMI patients with multi-vessel lesions,which can improve cardiac function and myocardial microcirculation,alleviate myocardial injury and inhibit inflammatory response,and reduce the occurrence of MACE after PCI.The mechanism may be related to inhibiting the activation of Wnt/β-catenin pathway.
作者
李小霞
刘浩
姚超然
LI Xiao-xia;LIU Hao;YAO Chao-ran(Department of Western Medicine,Cangzhou Hospital of Integrated Chinese and Western Medicine,Cangzhou 061001,China)
出处
《中国心血管病研究》
CAS
2024年第9期782-788,共7页
Chinese Journal of Cardiovascular Research
基金
河北省重点研发计划项目(20210380806D)。
关键词
急性心肌梗死
多支病变
经皮冠状动脉介入治疗
替格瑞洛
氯吡格雷
心肌损伤
心功能
Acute myocardial infarction
Multiple vessel lesions
Percutaneous coronary intervention
Ticagrelor
Clopidogrel
Myocardial injury
Cardiac function
