摘要
目的 评估冠心宁片与重组人脑利钠肽联合应用于急性ST段抬高型心肌梗死患者的临床治疗效果。方法 选取浙江省中西医结合医院2021年10月至2023年10月收治的80例急性ST段抬高型心肌梗死患者。采用随机数字表法将所有急性ST段抬高型心肌梗死患者分为对照组和观察组(n=40),其中对照组心肌梗死患者予以重组人脑利钠肽治疗,观察组心肌梗死患者联合使用冠心宁片和重组人脑利钠肽进行治疗。比较两组患者的总有效率、心肌损伤标志物、心功能、血管内皮功能、主要不良心血管事件(MACE)发生率。结果 观察组的总有效率为95.00%(38/40),高于对照组的77.50%(31/40)(χ^(2)=5.165,P=0.023)。治疗1个月后,观察组和对照组患者血清心肌肌钙蛋白Ⅰ(cTnⅠ)、肌酸激酶心肌同工酶(CK-MB)水平[分别是(0.24±0.03)μg·L^(-1)、(22.39±3.12) U·L^(-1)、(0.51±0.12)μg·L^(-1)、(30.07±3.86) U·L^(-1)],低于治疗前[分别是(1.42±0.26)μg·L^(-1)、(36.27±4.44) U·L^(-1)、(1.45±0.27)μg·L^(-1)、(36.02±4.41) U·L^(-1)],且观察组患者血清cTnI、CK-MB水平低于对照组(均P<0.05)。治疗1个月后,观察组和对照组患者左心室收缩末期内径(LVESD)和左心室舒张末期内径(LVEDD)分别为[(37.05±4.32) mm、(43.33±5.27) mm、(42.15±4.82) mm、(47.02±5.46) mm],均低于治疗前[分别为(48.31±5.59) mm、(48.25±5.57) mm、(53.17±6.21) mm、(53.49±6.24) mm],且观察组LVEDD、LVESD低于对照组(均P<0.05)。治疗1个月后,观察组和对照组患者左心室射血分数(LVEF)[分别为(55.67±6.45)%、(45.37±5.78)%],高于治疗前[分别为(39.12±5.03)%、(39.37±5.06)%],且观察组LVEF高于对照组(均P<0.05)。治疗1个月后,观察组和对照组患者血清内皮素-1(ET-1)、血管内皮生长因子(VEGF)水平[分别为(74.13±8.24) ng·L^(-1)、(245.38±18.69) pg·L^(-1)、(82.08±9.16) ng·L^(-1)、(316.25±27.14) pg·L^(-1)],低于治疗前[分别为(93.47±10.36) ng·L^(-1)、(448.91±32.62) pg·L^(-1)、(93.15±10.21) ng·L^(-1)、(449.26±32.65) pg·L^(-1]),且观察组血清ET-1、VEGF水平低于对照组(均P<0.05)。治疗1个月后,观察组和对照组患者血清一氧化氮(NO)水平[分别为(61.07±7.24)μmol·L^(-1)、(54.62±6.1)μmol·L^(-1)],高于治疗前[分别为(41.36±5.33)μmol·L^(-1)、(41.02±5.27)μmol·L^(-1)],且观察组血清NO水平高于对照组(均P<0.05)。观察组的MACE发生率为(7.50%)低于对照组(25.00%)(χ^(2)=4.501,P=0.034)。结论 冠心宁片联合重组人脑利钠肽治疗急性ST段抬高型心肌梗死的临床效果表现优异,能够有效减轻心肌所受损伤,同时改善心脏功能以及血管内皮的功能状态,降低MACE发生率,有一定的临床应用前景。
Objective To evaluate the therapeutic efficacy of Guanxinning tablet combined with recombinant human brain natriuretic peptide for patients with acute ST segment elevation myocardial infarction(STEMI).Methods A total of 80 patients with STEMI treated at Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine from October 2021 to October 2023 were selected as the research subjects and divided into the control group(n=40)and the observation group(n=40)by random number table method.The patients in the control group received treatment with recombinant human brain natriuretic peptid while those in the observation group received treatment of the combination of Guanxinning tablet and recombinant human brain natriuretic peptide.The total efficiency,myocardial markers,cardiac function,endothelial function and incidence of major adverse cardiovascular events(MACE)were compared between the two groups.Results The effective rate was higher in observation group than in control group(95.00%(38/40)vs 77.50%(31/40))(χ^(2)=5.165,P=0.023).After one month,the levels of serum cardiac troponin I(cTnI)and creatine kinase myocardial isoenzyme (CK-MB) in the observation group and control group were (0.24±0.03) μg·L^(-1), (22.39±3.12) U·L^(-1) and (0.51± 0.12) μg·L^(-1), (30.07±3.86) U·L^(-1), respectively, which were lower than those before the treatment ((1.42±0.26) μg·L^(-1), (36.27± 4.44) U·L^(-1), (1.45±0.27) μg·L^(-1), (36.02±4.41) U·L^(-1), respectively). Furthermore, the concentrations of cTnI and CK-MB in the observation group were lower in comparison to those in the control group (P<0.05). The levels of LVESD and LVEDD in the observation group and control group were (37.05±4.32) mm, (43.33±5.27) mm, (42.15±4.82) mm, and (47.02±5.46) mm, respectively, which were lower than those before the treatment ((48.31±5.59) mm, (48.25±5.57) mm, (53.17±6.21) mm and (53.49± 6.24) mm, respectively), and they were significantly lower in observation group than in control group (P<0.05). The level of LVEF in the observation group and control group was (55.67±6.45) % and (45.37±5.78) %, respectively, which were higher than those before the treatment ((39.12±5.03) % and (39.37±5.06) %, respectively), and it was significnatly higher in the observation group than in the control (P<0.05). The levels of serum endothelin-1 (ET-1) and vascular endothelial growth factor (VEGF) in the observation group and control group were (74.13±8.24) ng·L^(-1), (245.38±18.69) pg·L^(-1), (82.08±9.16) ng·L^(-1), (316.25±27.14) pg·L^(-1), respectively, which were lower than thsoe before the treatment ((93.47±10.36) ng·L^(-1), (448.91±32.62) pg·L^(-1), (93.15±10.21) ng·L^(-1), (449.26± 32.65) pg·L^(-1), respectively), and they were remarkably lower in observation group than that in control group(P<0.05). The serum level of NO in the observation group was (61.07±7.24) μmol·L^(-1) and in the control group was (54.62±6.1) μmol·L^(-1), which was higher than that before the treatment ((41.36±5.33) μmol·L^(-1) and (41.02±5.27) μmol·L^(-1)). Furthermore, the serum level of NO was markedly higher inobservation group than that in control group(P<0.05). The incidence rate of MACE within the observation group (7.50%) was found to be lower compared to the control group (25.00%) (χ^(2)=4.501, P=0.034). Conclusion Guanxinning tablet combined with recombinant human brain natriuretic peptide has good clinical efficacy in the treatment of STEMI since it can reduce myocardial injury, improve cardiac function and vascular endothelial function and decrease the incidence of MACE. Therefore, it has a certain clinical application prospect.
作者
谢明斌
吴源鸿
金信垚
徐雨晴
Xie Ming-bin;Wu Yuan-hong;Jin Xin-yao;Xu Yu-qing(Department of Cardiovascular Medicine,Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine,Hangzhou 310003,China)
出处
《中国药物应用与监测》
CAS
2024年第5期656-660,共5页
Chinese Journal of Drug Application and Monitoring
基金
杭州市生物医药和健康产业发展扶持科技专项(2021WJCY003)。
关键词
急性ST段抬高型心肌梗死
冠心宁片
心功能
血管内皮功能
安全性
Acute ST segment elevation myocardial infarction
Guanxinning tablet
Heart function
Endothelial function of blood vessel
Safety
