冠状动脉注射替罗非班对STEMI患者直接PCI术中靶血管炎性介质表达的影响  

Changes of pro-inflammatory factor levels after intracornary tirofiban administration during primary percutaneous coronary intervention in patients with ST-elevation acute myocardial infarction

作　　者：钟鸣[1] 刘爱霞[1] 傅慎文[1] 郑新玲[1] 朱以军[1] 俆育红 

机构地区：[1]金华市中心医院心血管内一科,321000

出　　处：《浙江医学》2016年第7期472-475,共4页Zhejiang Medical Journal

基　　金：金华市重点科技项目(2011-3-008)

摘　　要：目的观察冠状动脉注射替罗非班对急性ST段抬高型心肌梗死(STEMI)患者直接经皮冠状动脉介入(PCI)术中炎性介质表达的影响。方法采用随机抽样法将患者分为治疗组(46例)和对照组(37例)。采用酶联免疫吸附法检测直接PCI术中靶血管炎性介质IL-6及TXA2浓度,观察其在用药前后的变化。通过冠状动脉造影评估TIMI血流分级,PCI术后行心电图检查计算ST段回落幅度。结果经冠状动脉注射替罗非班后,治疗组IL-6、TXA2值与对照组比较差异均有统计学意义(t=2.968、2.358,P<0.05或0.01);TIMI血流改善较对照组明显(x^2=4.273,P<0.05),TIMI帧数少于对照组(t=2.062,P<0.05);治疗组心电图ST段回落较对照组明显(t=2.163,P<0.05)。结论冠状动脉注射替罗非班通过抑制靶血管炎性介质IL-6及TXA2表达改善心肌灌注。相比静脉给药,冠状动脉注射替罗非班能更好地发挥抗血小板、抗炎特性,改善冠状动脉血流及心肌灌注。Objective To investigate the effects of intracoronary tirofiban administration on pro-inflammatory factor levels in target vessel in patients with ST-elevation acute myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）. Methods Eighty three STEMI patients undergoing PCI were randomly assigned in two groups： 46 patients received intracoronary tirofiban administration during the procedure as study group and 37 patients did not receive tirofiban as control group. IL-6 and TXA2 levels were measured immediately before the administration of tirofiban and after stent placement. Results IL-6 and TXA2 levels in target vessels after PCI were significantly lower in study group than those in control group （t=2.968 and 2.358, P〈0.05 and 0.01, respectively）. After the administration of intracoronary tirofiban, thrombolysis in myocardial infarction （TIMI） flow grade significantly increased （x^2=4.273, P〈0.05）. TIMI frame count in intracoronary tirofiban group was better than that in control group （t=2.062, P 〈0.05）. ST-segment resolution on electrocardiogram enlarged in intracoronary tirofiban group （t=2.163, P〈0.05）. Conclusion Intracoronary administration of tirofiban can improve myocardial perfusion, which may be associated with inhibiting the pro-inflammatory factors （IL-6 and TXA2） levels in target vessel.

关 键 词：急性ST段抬高型心肌梗死 直接PCI 替罗非班 炎性介质 

分 类 号：R542.22[医药卫生—心血管疾病]