乌司他汀对经皮冠状动脉介入治疗后慢血流或无复流现象的影响  

Effects of ulinastatin slow flow and no reflow phenomenon during emergency percutaneous coronary artery intervention

作　　者：梁健球[1] 白书昌 吴剑弟[1] 李琛[1] 夏张青[1] 王玉燕[1] 欧小敏[1] 蹇祥玉[1] 罗健文 LIANG Jian-qiu BAI Shu-chang WU Jian-di LI Chen XIA Zhang-qing WANG Yu-yan OU Xiao-min JIAN Xiang-yu LUO Jian-wen(Department of Cardiology, The Second People ＇s Hospital of Foshan , Foshan 528000, Chin)

机构地区：[1]佛山市第二人民医院心内科,广东佛山528000 [2]广东省南海区第四人民医院心内科

出　　处：《中国介入心脏病学杂志》2017年第9期520-524,共5页Chinese Journal of Interventional Cardiology

基　　金：广东省心血管用药研究基金(2011×32);中国医师协会阳光心血管研究基金(SCRFCMDA201234);广东省自然科学基金(S2012010008207);佛山市医学重点专科项目(FSZDZK135027);佛山市医学省级重点专科培育项目(Fspy3-2015020)

摘　　要：目的探讨乌司他汀对急性ST段抬高型心肌梗死(STEMI)行经皮冠状动脉介入治疗(PCI)后对梗死相关血管慢血流或无复流的影响。方法入选符合条件的STEMI患者180例,分为两组:常规PCI组100例,采用PCI治疗方式;乌司他汀+PCI组80例,在PCI方式上加用乌司他汀。比较两组患者的血清炎症因子白介素-6、白介素-10、超氧化物歧化酶水平及梗死相关动脉TIMI血流分级(TFG)、TIMI心肌灌注分级(TMPG)、术后超声心动图结果及临床预后情况。结果乌司他汀+PCI组术后白介素-6与常规PCI组比较,显著下降,差异有统计学意义(P<0.05);术后白介素-10、超氧化物歧化酶与常规PCI组比较,显著上升,差异均有统计学意义(均P<0.05)。术后乌司他汀+PCI组TFG 0~Ⅰ级(5.0%比18.0%,P=0.016),TFGⅡ~Ⅲ级(95.0%比82.0%,P=0.028),TMPG 0~1级(7.5%比20.0%,P=0.024),TMPG 2~3级(92.5%比80.0%,P=0.002)患者比例较常规PCI组均有显著变化。术后乌司他汀+PCI组左心室舒张末期内径[(50.4±4.6)mm比(54.6±5.2)mm,P=0.046],左心室射血分数[(62.2±9.8)%比(58.4±10.2)%,P=0.048)]与常规PCI组比较,均有显著变化。乌司他汀+PCI组主要不良心血管事件(MACE)在住院期间(1.2%比5.0%,P=0.038)、1个月(1.2%比3.0%,P=0.046)以及6个月(3.8%比12.0%,P=0.018)发生率均较常规PCI组显著降低。结论与常规PCI组相比,乌司他汀+PCI组相关梗死血管的慢血流或无复流发生率低,心功能改善较好,MACE发生率低。Objective To study the effect of ulinastatin on no reflow or slow flow in the infarct related artery in patient with acute ST-elevation myocardial infarction（STEMI） undergoing emergency percutaneous coronary interventional therapy（PCI）.Methods 180 STEMI patients were divided into the control group（n=100） and the ulinastatin treatment group（n=80）.The control group received conventional PCI treatment and the treatment group received conventional PCI treatment plus ulinastatin. The level of serum inflammatory factors IL-6,IL-10,superoxide converting enzyme,the infarct related coronary artery reperfusion TIMI flow grade（TFG） and myocardial perfusion grade（TMPG）,the results of postoperative cardiac ultrasound examination and clinical outcomes were compared between the two groups.Results Compared with the control group,the level of IL-6 was decreased,while the levelsof IL-10 and superoxide converting enzyme were increased significantly in the ulinastatin treatment group（P〈0.05）.The TFG and TMPG of the infarct related vessels were increased significantly in the ulinastatin treatment group. The left ventricular end diastolic diameter[（54.6 ± 5.2 mm vs.（50.4±4.6）mm,P=0.046）]and left ventricular ejection fraction [（58.4±10.2） % vs.（62.2±9.8） % P=0.048]showed statistical difference between the two groups.Compared to the control,the major cardiovascular event rate of the treatment group during hospitalization（1% vs. 5%, P=0.038）, after one month（1.2% vs. 3%,P=0.046） and 6 months（3% vs 12%,P=0.018） were all signifi cantly lower.There was no signifi cant difference in mortality between the 2 groups.Conclusion Ulinastatin may lower the incidence of no fl ow and slow fl ow after emergency PCI,improve heart function and the lower the rates of MACE.

关 键 词：乌司他汀 急性心肌梗死 经皮冠状动脉介入治疗 无复流 心肌灌注 

分 类 号：R541.4[医药卫生—心血管疾病]