冠脉内逆向应用重组人尿激酶原溶栓联合PCI对急性ST段抬高型心肌梗死患者预后的临床研究  

Clinical study of intracoronary reverse application of recombinant human prourokinase thrombolysis combined with PCI on the prognosis of patients with acute ST-segment elevation myocardial infarction

作　　者：陈晓敏 葛广豪[2] 曹华[2] 张立[2] 刘化进[2] 王宏伟[2] 张琼 乔增勇[2] 马江伟 CHEN Xiaomin;GE Guanghao;CAO Hua;ZHANG Li;LIU Huajin;WANG Hongwei;ZHANG Qiong;QIAO Zengyong;MA Jiangwei(Anhui University of Science and Technology,Huainan,Anhui,232000*China;Department of Cardiology,The South Branch of the Sixth People’s Hospital,Shanghai Jiaotong University)

机构地区：[1]安徽理工大学,安徽准南232000 [2]上海交通大学附属第六人民医院南院心内科

出　　处：《临床心血管病杂志》2022年第6期489-494,共6页Journal of Clinical Cardiology

基　　金：上海市奉贤区科学技术委员会课题(No:20191204)。

摘　　要：目的:探讨冠状动脉(冠脉)内逆向应用重组人尿激酶原联合经皮冠脉介入治疗(PCI)对ST段抬高型心肌梗死(STEMI)患者预后的影响。方法:选择心内科行急诊PCI的STEMI患者120例,随机分为直接PCI组(A组)、血栓抽吸+PCI组(B组)、PCI+冠脉内正向溶栓组(C组)及冠脉内逆向溶栓+PCI组(D组),每组各30例。比较4组基线资料、术后TIMI血流分级、校正TIMI帧数计数(CTFC)、2 h ST段回落率(STR)≥50%的比例、无复流/慢血流(NR/SF)发生率、左心室射血分数(LVEF)、肌钙蛋白I(cTnI)和B型利钠肽(BNP)峰值。记录随访3个月的LVEF、主要不良心血管事件(MACEs)及TIMI出血情况,对相关指标进行比较。结果:(1)D组与A、B、C组比较,术后TIMI血流≤2级发生率、CTFC、NR/SF发生率、cTnI及BNP峰值显著降低,术后2 h STR≥50%的比例、LVEF显著升高(P<0.05);(2)随访3个月D组心力衰竭再住院发生率显著低于A、B、C组,且LVEF显著升高(P<0.05);(3)随访3个月,4组TIMI出血发生率差异无统计学意义(P>0.05)。结论:冠脉内逆向应用重组人尿激酶原联合PCI可有效地降低STEMI患者NR/SF发生率,改善心肌微循环灌注,减少心肌细胞坏死,改善患者左心室收缩功能及其预后,且不增加出血风险。Objective:To investigate the effect of intracoronary reverse application of recombinant human prourokinase combined with PCI on the prognosis of patients with ST-segment elevation myocardial infarction(STEMI).Methods:One hundred and twenty patients with STEMI undergoing emergency PCI in the cardiology department were selected and randomly divided into PCI group(Group A),thrombus aspiration+PCI group(Group B),PCI+intracoronary forward thrombolysis group(Group C)and intracoronary arterial retrograde thrombolysis+PCI group(Group D),with 30 patients in each group.Baseline data,postoperative TIMI blood flow classification,corrected TIMI frame count(CTFC),the percentage of 2 h ST-segment resolution(STR)≥50%,the incidence of no-reflow/slow flow(NR/SF),left ventricular ejection fraction(LVEF),peak cardiac troponin I(cTnI)and brain natriuretic peptide(BNP)were compared among the four groups.LVEF,major adverse cardiovascular events(MACEs),and TIMI bleeding were recorded at 3 months of follow-up,and the relevant indicators were compared.Results:(1)In group D,the incidence of TIMI flow≤grade 2,CTFC,NR/SF incidence,cTnI and BNP peak were significantly lower,and the percentage of 2 h STR≥50%and LVEF were significantly higher(all P<0.05)than those in groups A,B,and C.(2)The incidence of rehospitalization for heart failure was significantly lower and LVEF was significantly higher in group D than those in groups A,B,and C at 3 months of follow-up(P<0.05).(3)The difference in the incidence of TIMI bleeding among the four groups at 3 months of follow-up was not statistically significant(P>0.05).Conclusion:Intracoronary reverse application of recombinant human prourokinase combined with PCI is effective in reducing the incidence of NR/SF,improving myocardial microcirculatory perfusion,reducing myocardial cell necrosis,and improving left ventricular systolic function and its prognosis in patients with STEMI without increasing the risk of bleeding.

关 键 词：急性ST段抬高型心肌梗死 冠脉内逆向溶栓术 无复流/慢血流 重组人尿激酶原 

分 类 号：R541.4[医药卫生—心血管疾病]