梗死前心绞痛对ST段抬高型心肌梗死患者远端缺血预处理疗效的影响  

Effect of preinfarction angina on remote ischemic preconditioning in patients with ST-segment elevation myocardial infarction

作　　者：沙威威 杨煜 陆远 张敏 SHA Weiwei;YANG Yu;LU Yuan;ZHANG Min(Department of Cardiovascular Diseases,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)

机构地区：[1]徐州医科大学附属医院心血管内科,江苏徐州221002

出　　处：《徐州医科大学学报》2020年第1期33-37,共5页Journal of Xuzhou Medical University

摘　　要：目的探讨梗死前心绞痛对ST段抬高型心肌梗死(STEMI)患者远端缺血预处理疗效的影响。方法选取徐州医科大学附属医院行急诊经皮冠状动脉介入治疗的153例STEMI患者为研究对象,随机分为远端缺血预处理组与对照组,再根据是否存在梗死前心绞痛,将患者分为梗死前心绞痛组与非梗死前心绞痛组,观察并比较各组及其亚组患者术后肌钙蛋白T(Tn-T)峰值、肌酸激酶同工酶(CK-MB)水平等资料,进行统计分析。结果远端缺血预处理组患者术后Tn-T峰值与术后CK-MB曲线下面积低于对照组(P<0.01);在远端缺血预处理组中,存在梗死前心绞痛的亚组患者CK-MB曲线下面积低于非梗死前心绞痛的亚组患者(P<0.01)。梗死前心绞痛组患者术后Tn-T峰值与术后CK-MB曲线下面积均低于非梗死前心绞痛组(P<0.05);在梗死前心绞痛组与非梗死前心绞痛组,远端缺血预处理均有效减少CK-MB曲线下面积(P<0.01)。交互分析发现远端缺血预处理与梗死前心绞痛无交互作用(P>0.05)。结论远端缺血预处理和梗死前心绞痛均能够有效改善急性STEMI患者缺血再灌注损伤。远端缺血预处理对心肌损伤的保护作用不受梗死前心绞痛影响。Objective To investigate the effect of preinfarction angina(PA)on remote ischemic preconditioning(RIPC)in patients with ST-segment elevation myocardial infarction(STEMI).MethodsA total of 153 patients with acute STEMI undergoing emergency percutaneous coronary intervention in the Affiliated Hospital of Xuhou Medical University were enrolled and were randomly divided into the RIPC group and the control group.Then the patients were divided into the PA group and the non-PA group according to the existence of PA.The peak value of postoperative troponin T(Tn-T),creatine kinase isoenzyme(CK-MB)and other data after operation in each group and its subgroups were observed and statistically analyzed.Results The peak value of postoperative Tn-T and the CK-MB area under the curve in the RIPC group were significantly lower than those in the control group(P<0.01).In the RIPC group,the CK-MB area under the curve was lower in patients with PA than in patients without PA(P<0.01).Both the postoperative Tn-T peak value and the CK-MB area under the curve in the PA group were lower than those in the non-PA group(P<0.05).Either in the PA group or non-PA group,RIPC was effective in reducing the CK-MB area under the curve(P<0.01).No interaction between RIPC and PA was observed in multiple linear regression analysis(P>0.05).ConclusionsBoth the remote ischemic preconditioning and preinfarction angina can effectively reduce ischemia-reperfusion injury in acute STEMI patients.Furthermore,the protective effect of remote ischemic preconditioning on myocardial injury is not affected by preinfarction angina.

关 键 词：远端缺血预处理 梗死前心绞痛 ST段抬高型心肌梗死 缺血再灌注损伤 心脏保护 

分 类 号：R541.4[医药卫生—心血管疾病]