介入治疗时靶血管内给予尿激酶原对急性心肌梗死患者心肌微灌注和血清GDF15、脂质运载蛋白-2的影响  

Effects of target intravascular administration of prourokinase on myocardial microperfusion and serum GDF15 and lipocalin-2 in patients with acute myocardial infarction during during percutaneous coronary intervention

作　　者：崔福胜 王义文 张旭 CUI Fusheng;WANG Yiwen;ZHANG Xu(Department of Cardiology,Dandong First Hospital,Dandong Liaoning 118000,China)

机构地区：[1]丹东市第一医院心内科,辽宁丹东118000

出　　处：《中国急救复苏与灾害医学杂志》2022年第12期1552-1556,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：辽宁省科技厅自然科学基金项目(编号:20170540358)。

摘　　要：目的初步探讨通过PCI在靶血管内注射尿激酶原治疗急性心肌梗死(AMI)的疗效,观察其对心肌微灌注、血清GDF-15及Lcn-2水平等指标影响,并评估治疗的安全性。方法选择丹东市第一医院2020年1月—2021年1月期间收治的AMI发病时间在12 h以内的患者80例,将其按照随机数字表法分为观察组44例和对照组36例。对照组PCI术在靶血管病变部位注射山莨菪碱,观察组则给予注射尿激酶原。观察两组患者的校正的TIMI帧数(CTFC)、TIMI心肌血流灌注分级(TMPG)、ST段回落变化、左心室射血分数(LVEF)、左心室舒张末径(LVEDD)、室壁运动积分指数(WMSI)、血清生长分化因子-15(GDF-15)、脂质运载蛋白-2(Lcn-2)及心血管不良事件(MACE)发生率。结果观察组的CTFC明显比对照组降低;TMPG分级明显优于对照组;ST段回落>50%的患者明显比对照组更多(P<0.05);心功能指标中观察组的LVEF、LVEDD及WMSI明显优于对照组(P<0.05);术后24 h及72 h,观察组的GDF-15、Lcn-2比对照组显著降低(P<0.05);两组的术后1个月、3个月MACE发生率对比差异无统计学意义(P>0.05)。结论AMI患者PCI治疗经靶血管内使用尿激酶原显著改善心肌组织的灌注和心功能,并有效降低患者体内的GDF-15、Lcn-2水平,从而减轻心肌梗死病灶的炎性反应,有助于改善患者的预后。Objective To investigate the efficacy of target intravascular administration of prourokinase on myocardial microperfusion and serum growth differentiation factor-15(GDF-15)and lipcalin-2(Lcn-2)in patients with acute myocardial infarction(AMI)during percutaneous coronary intervention(PCI).Methods:80 patients with AMI with the onset time within 12 hours were randomLy divided into 2 groups:control group(n=36),undergoing injection of anisodamine into the target vessel lesion after PCI and observation group(n=44),undergoing injection of prourokinase into the target vessel lesion after PCI.The corrected number of TIMI frames(CTFC)TIMI myocardial perfusion grade(TMPG)and ST segment decline rate were observe.One week after PCI ultrasonic examination was conducted to measure the left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter.(LVEDD),and wall motion score index(WMSI).Peripheral venous blood samples were collected before PCI and 24 h and 72 h after PCI to measure the levels of GDF-15,and Lcn-2 by ELISA.Follow-up was conducted 1 and 3 months after PCI to observe the incidence of major adverse cardiovascular events(MACE).Results The CTFC of the observation group was significantly lower than that of the control group,the TMPG grade of the observation group was significantly better than that of the control group,and the number of patients with ST segment decline>50%was significantly higher than that of the control group(all P<0.05).The cardiac function indexes of the observation group were all significantly better than those of the control group(all P<0.05).24 hours and 72 hours after operation,both the GDF-15 and Lcn-2 levels of the observation group were significantly lower than those of the control group(both P<0.05).There was no significant difference in the incidence of MACE between the two groups 1 month and 3 months after operation.Conclusion Significantly improving the myocardial perfusion and cardiac function,and reducing the levels of GDF-15 and Lcn-2 in the patients with AMI,intravas

关 键 词：急性心肌梗死 经皮冠脉介入术 尿激酶原 心肌微灌注 生长分化因子-15 脂质运载蛋白-2 

分 类 号：R54[医药卫生—心血管疾病]