远程缺血预适应对经皮冠状动脉介入治疗患者的心肌保护作用  

Remote ischemic preconditioning provides cardio protection in patients received percutaneous coronary intervention

作　　者：张慧[1] 孙素娟 毕媛晓 张琦 方哲 ZHANG Hui;SUN Su-juan;BI Yuan-xiao;ZHANG Qi;FANG Zhe(NO.2 Cardiovascular Department,Baishan Central Hospital,Baishan 134300,China;Department of Cardiology,Yanbian University Hospital,Yanji 133000,China;Department of Cardiology,Daxing Hospital Affiliated To Capital Medical University,Beijing 102600,China)

机构地区：[1]白山市中心医院心内二科,吉林省白山市134300 [2]延边大学附属医院心内科 [3]首都医科大学大兴教学医院心血管诊疗中心

出　　处：《中国心血管病研究》2022年第1期30-35,共6页Chinese Journal of Cardiovascular Research

基　　金：首发公卫项目(项目编号:首发2021-1G-7121)。

摘　　要：目的探讨远程缺血预适应对择期行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的冠心病患者的心肌保护作用。方法选取2019年1月至2019年12月于延边大学附属医院择期行PCI的冠心病患者152例,选用随机数字表法将100名入选者分为远程缺血预适应组(remote ischemic preconditioning,RIPC组)50例和对照组50例。RIPC组于PCI前24 h内实施单侧上肢缺血预适应操作。比较术前、术后及出院前心肌肌钙蛋白I(cardiac troponin I,cTnI)、肌酸激酶(creatine phosphokinase,CK)、肌酸激酶同工酶MB(creatine kinase MB,CK-MB)、血肌酐(serum creatinine,Scr)和超敏C反应蛋白(high-sensitive C-reactive protein,hs-CRP)的水平,并评估对远期心血管事件的影响。结果 RIPC组术中心率、造影剂用量、出现胸痛及ST段偏移>1 mm比率均低于对照组(P=0.015、P=0.019、P=0.037、P=0.038)。RIPC组术后24 h内和出院前的cTnI、CK、CK-MB及Scr升高水平较对照组降低(术后24 h:P=0.002、P=0.002、P=0.002、P=0.032;出院前:P=0.021、P=0.027、P=0.038、P=0.021)。RIPC组PCI术后6个月、1年的主要心血管不良事件(major adverse cardiac events,MACE)发生率低于对照组(P=0.046、P=0.033)。结论 RIPC能够减轻PCI相关的心肌损伤、降低造影剂肾病的发生率并改善临床预后,是一项安全有效,临床可行性高的保护措施。Objective To assess the myocardial protective effect of remote ischemic preconditioning(RIPC) on patients with coronary heart disease(CHD) undergoing percutaneous coronary intervention(PCI).Methods One hundred and fifty two patients with coronary heart disease who underwent PCI in the Yanbian University Hospital from January 2019 to December 2019 were enrolled.According to the method of random number table,one hundred participants were divided into RIPC group(N=50) and control group(N=50).Unilateral upper limb ischemic preconditioning was performed in the RIPC group within 24 hours before PCI.The levels of cardiac troponin I(cTnI),creatine kinase(CK),creatine kinase MB(CK-MB),serum creatine(Scr) and high sensitive C-reactive protein(hs-CRP) were compared before and after PCI and before discharge.The impact on long-term major adverse cardiac events were assessed.Results The heart rate,dosage of contrast medium,chest pain and ST segment deviation >1 mm in RIPC group were lower than those in control group(P=0.015,P=0.019,P=0.037,P=0.038).The elevated levels of c Tn I,CK,CK-MB and SCR in RIPC group within 24 hours after PCI and before discharge were lower than those in control group(24 hours after PCI:P=0.002,P=0.002,P=0.002,P=0.032;before discharge:P=0.021,P=0.027,P=0.038,P=0.021).The incidence of major adverse cardiac events(MACE) at 6 months and 1 year after PCI in the RIPC group was lower than that in the control group(P=0.046、P=0.033).Conclusion RIPC can alleviate the myocardial reperfusion injury,reduce the rate of CIN and improve clinical prognosis in patients with CHD after PCI.It is a safe,effective and clinically feasible myocardial protection measure.

关 键 词：远程缺血预适应 冠心病 经皮冠状动脉介入治疗 心肌损伤 心肌肌钙蛋白I 

分 类 号：R541.4[医药卫生—心血管疾病]