| 摘要: |
| 目的探讨急性ST段抬高型心肌梗死（STEMI）患者在经皮冠状动脉介入治疗（PCI）术后应用羟苯磺酸钙的疗效。方法选取2013年10月至2016年10月急诊PCI治疗的164例STEMI患者，分为两组，对照组给予指南规定用药，研究组在对照组用药基础上术后当日予以羟苯磺酸钙500mg/次，3次/d，连续应用3个月。对比两组患者术后72h内肌酸激酶同工酶（CK-MB）、血清肌钙蛋白I（cTNI）峰值及其释放的峰值曲线下面积；术前及术后3个月心超检查结果；术后3个月6min步行试验（6MWT）结果；术前及术后多个时间点检测血清N端B型利尿肽前体（NT-proBNP）、高敏C反应蛋白（hs-CRP）、内皮素-1（ET-1）、一氧化氮（NO）含量；检测血液流变学相关指标，包括全血黏度、血浆黏度、红细胞聚集指数(EDI)和血小板聚集率等。结果术后两组CK-MB、cTNI峰值及其释放的峰值曲线下面积无差别。术后3个月研究组左室舒张末容积（LVEDV）、左室收缩末容积（LVESV）、左室射血分数（LVEF）、室壁运动计分指数（WMSI）、6MWT均显著优于对照组。研究组NT-proBNP、hs-CRP、ET-1显著低于对照组，而NO含量高于对照组；研究组血液流变学相关指标明显改善。结论STEMI患者在PCI术后应用羟苯磺酸钙虽短时间内并不能减少心肌梗死面积，但3个月后能改善心功能。这可能与羟苯磺酸钙通过改善冠状动脉内皮功能和血液流变学性能，进而改善冠状动脉微循环、抑制STEMI区域的局部炎症反应有关。该药可作为心肌梗死再灌注治疗后的辅助用药应用于临床。 |
| 关键词: 急性 ST 段抬高型心肌梗死 经皮冠状动脉介入治疗 羟苯磺酸钙 冠状动脉微循环 |
| DOI：10.12056/j.issn.1006-2785.2017.39.17.2017-282 |
| 分类号: |
| 基金项目:浙江省重大科技专项计划项目（2012C13018-1）；浙江省医药卫生科技项目（2015128660） |
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| Efficacy of calcium dobesilate for patients with acute ST-segment elevation myocardial infarction after emergency |
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Cixi Hospital of Wenzhou Medical University
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| Abstract: |
| Objective To evaluate the efficacy of calcium dobesilate (CD) for patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods One hundred and sixty four patients with STEMI who underwent emergency PCI treatment from October 2013 to October 2016 were randomly divided into two groups. The control group received the conventional treatment, CD (500mg tid, for 3 months) was given to study group in addition to conventional treatments. The serum levels of creatine kinase MB (CK-MB) and troponin I (TnI) were measured within 72h after operation. The serum levels of N-terminal probrain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), endothelin-1 (ET-1), nitric oxide (NO) and the hemorheology parameters, including whole blood viscosity, plasma viscosity, erythrocyte aggregation index (EDI) and platelet aggregation rate were detected before and at various time points after operation. Echocardiography and 6-minute walk test (6MWT) were performed 3 after months after PCI treatment. Results Baseline characteristics were similar between two groups. There was no statistic difference in infarct size expressed as the AUC of CK-MB and TnI between two groups. Left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and 6MWT were significantly higher in the study group than those in control group at 3 months postoperatively. The levels of NT-proBNP, hs-CRP and ET-1 in the study group were significantly lower than those in the control group. Besides, the NO content in study was higher than that in the control group. The hemorheology was significantly improved in the study group. Conclusion CD does not reduce the infarct size shortly after emergency PCI in patients with STEMI. However, it can improve cardiac function later, which may be related to the improvement of coronary microcirculation by reducing the systemic inflammatory response, ameliorating coronary endothelial function and hemorheological properties. The drug can be used as adjunctive therapy in the treatment of myocardial infarction after reperfusion. |
| Key words: Acute ST-segment elevation myocardial infarction Percutaneous coronary intervention Calciumdobesi- late Coronary microcirculation |
