冠脉内注射替罗非班对急诊介入治疗急性心肌梗死患者甲状腺功能的影响  

Effect of intracoronary tirofiban on thyroid function in patients with ST segment elevate acute myocardial infarction undergoing percutaneous coronary intervention

作　　者：陈灵芝[1] 周浩[2] 黄茜茜[1] 徐克[1] 

机构地区：[1]温州医学院定理临床学院检验科,325011 [2]温州医学院附属第一医院心血管内科

出　　处：《浙江医学》2013年第10期871-873,共3页Zhejiang Medical Journal

基　　金：温州市科技局科研基金资助项目(Y20080237)

摘　　要：目的观察冠状动脉(冠脉)内注射替罗非班对急性心肌梗死(AMI)直接经皮冠状动脉介入(PCI)治疗患者甲状腺功能的影响。方法选择因急性ST段抬高心肌梗死入院,并接受直接PCI治疗患者92例,随机分为试验组(冠脉内注射替罗非班+PCI)42例和对照组(静脉注射替罗非班+PCI)50例。观察两组PCI术前、术后TIMI血流情况,术后甲状腺功能(血清T_3、T_4、TSH水平),术后30d心脏射血分数(EF),30d主要心血管事件。结果两组PCI术前冠脉造影血流的差异无统计学意义,PCI术后即刻、术后30min试验组达TIMI 3级血流的比例高于对照组(P<0.05);试验组血清T3水平及30d EF均高于对照组(均P<0.05),试验组30d内主要心血管事件的发生率较对照组降低(P<0.05)。两组出血相关并发症的差异无统计学意义(P>0.05)。结论冠脉内注射替罗非班可在AMI直接PCI治疗中改善患者的低T_3综合征,从而改善其术后心肌灌注,降低心血管事件发生率,且不增加出血的风险。Objective To investigate the effect of intracoronary tirofiban in patients with ST segment elevate acute my-ocardium infarction （STEMI） treated by primary percutaneous coronary intervention （PCI）. Methods Ninety-two STEMI patients undergoing PCI were randomized to receive intracoronary or intravenous tirofiban administration. The thrombolysis in myocardial infarction （TIMI） flow grate before and after the operation were reviewed. Serum tri odothyronine （T3）, tetraiodothyronine （T4） and thyroid-stimulating hormone （TSH） were measured by radioimmunoassay. Ejection fraction （EF） and the major cardiovascular events in 30d were measured. Results There was no difference in TIMI flow grades between two groups before PCI. A greater percentage of TIMI grate 3 flow was achieved in patients with intracoronary tirofiban compared to intravenous administration im-mediately（P〈0.05） and 30min after PCI（P〈0.05）. The level of T3 was higher in patients with intracoronary administration than that with intravenous administration （P〈0.05）. Ejection fraction （EF） at d30 was higher in intracoronary use group compared to that in intravenous use group（P〈0.05）. The frequency of the primary end points at d30 was lower in intracoronary use group than that in intravenous use group（P〈0.05）. There was no difference in bleeding complications between two groups. Conclusion Intracoro-nary administration of tirofiban is effective and safe in improvement of thyroid function and cardiac perfusion for patients with STEMI treated by primary PCI.

关 键 词：替罗非班 心肌梗死 正常甲状腺功能病态综合征 

分 类 号：R542.22[医药卫生—心血管疾病]