丹红注射液对急性心肌梗死直接经皮冠状动脉介入术后缺血心肌的保护作用  

Protective effect of Danhong injection on the ischemic myocardium after percutaneous coronary intervention for acute myocardial infarction

作　　者：许新民 崔海明[2] 杨靖[2] 桂艳萍[2] 王家美[2] 任雨笙[2] 

机构地区：[1]上海警备区门诊部,上海200402 [2]第二军医大学长征医院心血管内科,上海200003

出　　处：《东南国防医药》2015年第5期451-454,共4页Military Medical Journal of Southeast China

基　　金：国家自然科学基金青年科学基金项目(81403258)

摘　　要：目的观察并比较丹红注射液对经皮冠状动脉直接介入术(percutaneous coronaryintervention,PCI)治疗急性心肌梗死患者的效果、安全性和机制。方法诊断符合的急性心肌梗死PCI术后患者随机分为丹红注射液治疗组(丹红组)和对照组,持续治疗14 d。治疗前后分别测定两组患者血清心肌坏死标志物[肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、肌钙蛋白T(c Tn T)]、血清脑钠肽(brain natriureticpeptide,BNP)、内皮素-1(endothelin-1,ET-1)浓度,心脏彩超测定左室射血分数(left ventricularejection fraction,LVEF)、心肌的纵向应变(longitudinal strain,LS)和径向应变(radial strain,RS),记录一般临床资料、症状、心电图变化、住院期间死亡率和药物不良反应。结果 1共入选71例患者,丹红组36例,对照组35例,两组间基线资料差异无统计学意义。2两组术后3 d血清心肌坏死标志物(CK、CK-MB、c Tn T)峰值及治疗14 d后BNP、ET-1比较,丹红组均低于对照组(P<0.05)。治疗后LVEF、LS、RS、ST段的回落(ST-segment resolution,STR)≥70%的比例,丹红组均优于对照组(P<0.05)。丹红组梗死后心绞痛发生率低于对照组(P<0.05)。但住院期间死亡率两组间无显著性差异。3丹红组有3例出现轻微不良反应,均可耐受,无严重不良反应。结论丹红注射液能够改善急性心肌梗死PCI术后冠脉微循环、减少梗死心肌、保留左室收缩功能、减少梗死后心绞痛发作。这些作用可能与ET-1水平降低有关。Objective To observe and compare the effect,safety and mechanism of Danhong injection（ DI） therapeusis in the patients with acute myocardial infarction（ AMI） after percutaneous coronary intervention（ PCI）. Methods Eligible patients were randomly divided into DI group and control group. All patients received standard treatment and DI group received DI additionally. Serum myocardial biomarkers,brain natriureticpeptide（ BNP）,endothelin-1（ ET-1）,and left ventricular ejection fraction（ LVEF）,radial strain（ LS）,radial strain（ RS） were measured. General clinical data,symptoms,ECG changes,hospitalization mortality and adverse drug reaction were recorded. Results Seventy-one patients were enrolled to DI group（ n = 36） and control group（ n = 35）.There was no difference between the two groups at baseline. Peak serum CK,CK-MB and cTnT,BNP,ET-1 were lower in DI group（ P〈0. 05）. LVEF,LS,RS and ratio of ST-segment resolution（ ≥ 70%） in DI group were better than control group（ P〈0. 05）.Incidence of postinfarction angina were lower in DI group（ P〈0. 05）. Adverse reactions of DI were observed rarely and tolerated.Conclusion In addition to guideline-recommended therapies in AMI patients after PCI,DI may improve coronary microcirculation,reduce myocardial infarction size,reserve LVEF and reduce angina pectoris. The beneficial effects could be related to the lower level of endothelin-1.

关 键 词：丹红注射液 急性心肌梗死 直接经皮冠状动脉介入术 心肌缺血 

分 类 号：R542.22[医药卫生—心血管疾病]