替罗非班对急性ST段抬高型心肌梗死合并2型糖尿病患者的影响  

Influence of tirofiban on patients with acute ST-segment elevation myocardial infarction complicated by type 2 diabetes mellitus

作　　者：肖立运[1] 李秀丽[1] Xiao Liyun;Li Xiuli(Department of Cardiology, People's Hospital of Jinxiang County,Jining 272000, China)

机构地区：[1]金乡县人民医院心内科,济宁272000

出　　处：《中国循证心血管医学杂志》2017年第11期1331-1333,1337,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：济宁市科学技术研究"十一五"规划科研启动基金项目B(02201462)

摘　　要：目的分析替罗非班对急性ST段抬高型心肌梗死(STEMI)合并2型糖尿病(T2DM)患者的影响。方法选取金乡县人民医院心内科于2012年1月~2014年1月收治的STEMI合并T2DM患者524例,其中男性310例,女性214例,年龄35~78(55.7±11.8)岁。所有患者随机分成A组(262例)和B组(262例)。两组均行急诊PCI,A组置入支架,B组在A组基础上指引导管局部注入替罗非班,术后维持24h。心肌梗死溶栓治疗(TIMI)血流分级和校正的TIMI帧数(cTFC)评价再灌注情况。心电图测定ST段回落情况。术后2h测定心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肌红蛋白。术前和术后3d测定白介素-6(IL-6)、C-反应蛋白(CRP)、脑钠肽(BNP)。两组术后1周、6个月、1年心脏超声测定左室射血分数(LVEF)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)。记录术后1个月内出血事件及主要不良心血管事件(MACE)。结果与A组比较,B组术后慢血流、无复流比例减少,TIMI 3级慢、快血流比例增加,差异有统计学意义(P均<0.05)。与A组比较,B组CKMB、cTnI以及肌红蛋白水平下降,ST段回落比例增加,差异有统计学意义(P均<0.05)。两组术后较术前CRP、IL-6以及BNP均升高,而A组升高更明显,差异有统计学意义(P均<0.05)。A组与B组术后1周LVESV、LVEDV、LVEF比较,差异无统计学意义(P均>0.05)。术后6个月、术后1年B组较A组LVESV、LVEDV减少,LVEF增加,差异有统计学意义(P均<0.05)。B组出血48例,A组出血27例,两组出血率比较(18.3%vs.10.3%),差异无统计学意义(P>0.05)。A组MACE发生率高于B组(11.8%vs.1.5%),差异有统计学意义。结论 STEMI合并2型糖尿病患者急诊PCI术中应用替罗非班可明显改善术后冠状动脉血流情况,减轻心肌损伤和炎症反应,提高心功能,安全性高。Objective To analyze the influence of tirofiban on patients with acute ST-segment elevation myocardial infarction(STEMI)complicated by type2diabetes mellitus(T2DM).Methods The patients with acute STEMI complicated by T2DM(n=524,male310,female214,aged from35to78and average age=55.7±11.8)were chosen from the Department of Cardiology of People’s Hospital of Jinxiang County from Jan.2012to Jan.2014.All patients were randomly divided into group A and group B(each n=262).Two groups were given emergency percutaneous coronary intervention(PCI),and group A was given stenting and group B was additionally given local tirofiban injection maintained for24h.The reperfusion status was reviewed by using thrombolytic test for myocardial infarction(TIMI)and corrected TIMI frame count(CTFC),and ST-segment resolution was detected by using electrocardiogram(ECG).The levels of cardiac troponin I(cTnI),creatine kinase-MB isoenzyme(CK-MB)and myoglobin(MYO)were detected after the operation for2h.The changes of interleukin-6(IL-6),C-reactive protein(CRP)and brain natriuretic peptide(BNP)were detected before and after the operation for3d.The levels of left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV)and left ventricular enddiastolic volume(LVEDV)were detected by using echocardiogram after the operation for1week,6months and1y.The bleeding events and major adverse cardiovascular events(MACE)were recorded after the operation for1month.Results The percentage of patients with slow flow and no reflow decreased,and percentage of patients with slow flow and fast flow of TIMI grade3increased in group B compared with group A(all P<0.05).The levels of CK-MB,cTnI and MYO decreased,and percentage of ST-segment resolution increased in group B compared with group A(all P<0.05).The levels of CRP,IL-6and BNP increased in2groups after the operation,which was more significant in group A(all P<0.05).The comparison in LVESV,LVEDV and LVEF had no statistical difference between group A and group B after the operation for1wee

关 键 词：急性ST段抬高型心肌梗死 盐酸替罗非班 经皮冠状动脉介入术 无复流 2型糖尿病 

分 类 号：R542.22[医药卫生—心血管疾病]