阿替普酶溶栓联合阿司匹林、氯吡格雷、依诺肝素治疗STEMI的疗效及其对患者血清NT-proBNP、Lp（a）、β2M水平的影响  

Efficacy of Alteplase thrombolysis combined with Aspirin, Clopidogrel and Enoxaparin in the treatment of STEMI and its effects on levels of serum NT-proBNP, Lp（a） and β2M

作　　者：李静[1] 周麟[2] LI Jing;ZHOU Lin(Department of Cardiology,3201 Hospital Affiliated to Medical College of Xi'an Jiaotong University,Shaanxi,Hanzhong 723000,China;Department of Nephrology,3201 Hospital Affiliated to Medical College of Xi'an Jiaotong University,Shaanxi,Hanzhong 723000,China)

机构地区：[1]西安交通大学医学院附属三二〇一医院心内科,陕西汉中723000 [2]西安交通大学医学院附属三二〇一医院肾内科,陕西汉中723000

出　　处：《中国医学前沿杂志（电子版）》2019年第6期43-47,共5页Chinese Journal of the Frontiers of Medical Science(Electronic Version)

基　　金：陕西省重点研发计划项目(2017ZDCXL-SF-02-04-02)

摘　　要：目的探讨阿替普酶溶栓联合阿司匹林、氯吡格雷、依诺肝素治疗急性ST段抬高型心肌梗死(ST segment elevationmyocardial infarction,STEMI)的疗效及其对患者血浆N末端B型利钠肽原(N-terminal pro-B-type natriuretic peptide,NTproBNP)、脂蛋白(a)[lipoproteina,Lp(a)]、β2微球蛋白(β2-microglobulin,β2M)水平的影响。方法选取本院2016年3月至2017年12月收治的STEMI患者130例为研究对象,均采用阿替普酶溶栓治疗,阿司匹林和氯吡格雷抗血小板治疗,依诺肝素抗凝治疗。治疗前、治疗1周、治疗3个月,分别检测患者NT-proBNP、肌酸激酶同工酶(creatine kinase isozyme-MB,CKMB)、Lp(a)、β2M水平及左室射血分数(left ventricular ejection fraction,LVEF)。随访6个月和1年,分别记录患者心血管不良事件及治疗期间不良反应发生情况。结果治疗1周和治疗3个月,患者NT-proBNP和CK-MB水平均显著低于治疗前(均P<0.05),且患者治疗3个月的NT-proBNP水平显著低于治疗1周的水平(P<0.05)。治疗3个月,患者LVEF均显著大于治疗前和治疗1周(均P<0.05),Lp(a)、β2M水平均显著低于治疗前和治疗1周(均P<0.05)。治疗6个月和1年,患者再梗死率分别为3.85%和6.92%,冠状动脉内血栓发生率分别为4.62%和10.77%,心源性猝死率分别为0.77%和3.85%,药物不良反应发生率低。结论阿替普酶溶栓联合阿司匹林、氯吡格雷及依诺肝素治疗可以明显改善STEMI患者心功能,有效预防心血管不良事件发生,对患者血清NT-proBNP、Lp(a)、β2M也具有良好的调节作用。Objective To explore the efficacy of Alteplase thrombolysis combined with Aspirin,Clopidogrel and Enoxaparin in the treatment of acute ST-segment elevation myocardial infarction (STEMI) and its effects on levels of plasma N-terminal pro-brain natriuretic peptide (NT-proBNP),lipoprotein(a)[Lp(a)] and β2-microglobulin (β2M).Method A total of 130 patients with STEMI treated in our hospital from March 2016 to December 2017 were treated with Atripase,Aspirin and Clopidogrel antiplatelet therapy and Enoxaparin anticoagulation therapy.The levels of NT-proBNP,creatine kinase isozyme-MB (CK-MB),Lp(a),β2M and left ventricular ejection fraction (LVEF) were measured before treatment,1 week and 3 months after treatment.All patients were followed up for 6 months and 1 year,and the incidence of cardiovascular adverse events and adverse reactions during treatment were recorded.Result The levels of NT-proBNP and CK-MB in patients after 1 week and 3 months of treatment were significantly lower than those before treatment (all P < 0.05),and the level of NT-proBNP in patients after 3 months of treatment was significantly lower than that of 1 week (P < 0.05).After 3 months of treatment,the levels of LVEF in patients were significantly higher than those before treatment and 1 week after treatment (all P < 0.05), while the levels of Lp(a) and β2M in patients were significantly lower than those before treatment and 1 week after treatment (all P< 0.05). After 6 months and 1 year of treatment,the reinfarction rate was 3.85% and 6.92%,the incidence of intracoronary thrombosis was 4.62% and 10.77%,and the sudden cardiac death rate was 0.77% and 3.85%,respectively.The incidence of adverse drug reactions was low. Conclusion Alteplase thrombolysis combined with Aspirin,Clopidogrel and Enoxaparin can significantly improve cardiac function, effectively prevent cardiovascular adverse events,and regulate serum NT-proBNP,Lp(a) and β2M in patients with STEMI.

关 键 词：急性ST段抬高型心肌梗死 阿替普酶 阿司匹林 氯吡格雷 依诺肝素 脑钠肽 脂蛋白(a) Β2微球蛋白 

分 类 号：R542.22[医药卫生—心血管疾病]