介入治疗前用替罗非班对中高危非ST段抬高急性冠状动脉综合征患者内皮功能的影响  

Effect of tirofiban on endothelial function in non-ST elevation acute coronary syndrome patients before PCI

作　　者：罗亚玮[1] 马小虎[2] 潘昱[1] 李全[1] 何继强[1] 张晓玲[1] 高阅春[1] 张维东[1] 陈方[1] 

机构地区：[1]首都医科大学附属北京安贞医院心内科北京市心肺血管疾病研究所,100029 [2]宁夏石嘴山市第二人民医院心内科

出　　处：《中华老年心脑血管病杂志》2015年第8期805-808,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：北京市医院管理局临床技术创新项目(XMLX201406)

摘　　要：目的 PCI前应用替罗非班对中高危非ST段抬高急性冠状动脉综合征(NSTACS)患者临床效果和内皮功能的影响。方法 100例中高危NSTACS患者均择期接受PCI,分为术前组50例(PCI术前静脉滴注替罗非班)和术中组50例(PCI开始时静脉滴注替罗非班),观察2组病变血管血流灌注及院内、30d主要心血管不良事件发生的影响和术前术后24h血清内皮素1和一氧化氮(NO)水平。结果术前组术后病变血管TIMI心肌灌注分级<3级的比例显著低于术中组(P=0.037);术前组基线血清内皮素1水平显著高于术后[(70.1±32.8)μg/L vs(55.9±29.5)μg/L,P=0.028],基线血清NO水平显著低于术后[(47.8±23.9)μmol/L vs(70.6±20.6)μmol/L,P=0.035);术前组术后血清内皮素1水平显著低于术中组[(55.9±29.5)μg/L vs(63.7±47.7)μg/L,P=0.044],血清NO水平显著高于术中组[(70.6±20.6)μmol/L vs(53.2±40.2)μmol/L,P=0.038]。2组患者院内和30d心血管不良事件比较无显著差异(P>0.05)。结论 PCI术前应用替罗非班能部分改善中高危NSTACS患者术后病变血管血流灌注,是通过内皮保护作用实现的,但是没有实现早期心血管不良事件的减少。Objective To study the effect of tirofiban on endothelin function in non-ST elevation acute coronary syndrome （NSTACS） patients before PCI. Methods One hundred NSTACS pa- tients who underwent PCI were divided into pre-PCI group （n=50） and pro-PCI group （n= 50）. Their vascular perfusion,major adverse cardiovascular events （MACE）,serum ET-1 and NO lev- els were recorded before and 24 h after PCI. Results The TIMI myocardial perfusion grade （TMPG）〈3 was significantly higher in pre-PCI group than in pro-PCI group after PCI （P= 0. 037）. The baseline serum ET-1 level was significantly higher while the baseline serum NO level was significantly lower in pre-PCI group than in pro-PCI group after PCI （70.1±32.8 μg/L vs 55.9±29.5 μg/L,P=0. 028347.8±23.9 μmol/L vs 70.6±20.6 μmol/L,P=0. 035）. The serum ET-1 level was significantly lower while the serum NO level was significantly higher in pre-PCI group than in pro-PCI group after PCI （55.9±29.5μg/L vs 63.7±47.7 μg/L,P=0. 044 ; 70. 6 ±20.6 μmol/L vs 53.2±40.2 μmol/L,P=0. 038）. No significant difference was found in MACE between the two groups after PCI（P〉0.05）. Conclusion Tirol＋ban improves myocardial perfu- sion by protecting the endothelial function but does not reduce the early MACE in NSTACS pa- tients after PCI.

关 键 词：急性冠状动脉综合征 内皮缩血管肽1 血小板膜糖蛋白类 替罗非班 

分 类 号：R541.4[医药卫生—心血管疾病]