尼可地尔联合远程缺血后适应对急性ST段抬高型心肌梗死急诊经皮冠状动脉介入的心肌保护作用  

Myocardial protective effect of nicorandil combined with remote ischemic post-conditioning on acute ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention

作　　者：王中明 曾辉[1] 韩风杰 晋辉[1] 刘静[1] 杭晓阳 郑海军 王晓飞 Wang Zhongming;Zeng Hui;Han Fengjie;Jin Hui;Liu Jing;Hang Xiaoyang;Zheng Haijun;Wang Xiaofei(Department of Cardiology,Jiaozuo People’s Hospital Affiliated to Xinxiang Medical College,Jiaozuo 454000,China)

机构地区：[1]新乡医学院附属焦作市人民医院心内科,焦作454000

出　　处：《中国心血管杂志》2023年第5期417-422,共6页Chinese Journal of Cardiovascular Medicine

基　　金：河南省医学科技攻关计划省部共建重大项目(SBGJ202101006)。

摘　　要：目的探讨尼可地尔联合远程缺血后适应(RIPostC)对急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入(PCI)的心肌保护作用。方法单中心、前瞻性、随机对照研究。连续纳入2018年1月至2021年9月在新乡医学院附属焦作市人民医院心内科病房接受PCI治疗的STEMI患者208例。按随机数字表法分为4组:A组(52例):常规PCI;B组(52例):RIPostC+常规PCI;C组(52例):尼可地尔+常规PCI;D组(52例):RIPostC+尼可地尔+常规PCI。于PCI术前后检测心肌灌注、心律失常、炎症反应、血管内皮功能、心肌损伤及心功能指标;记录术后12个月内主要不良心血管事件(MACE,包括再发心肌梗死、再发心力衰竭、心原性休克和心原性死亡)。结果(1)D组PCI术后即刻校正的TIMI血流帧数计数(CTFC)、术后24 h Curtis-Walker评分及恶性心律失常发生率均低于A组,术后2 h ST段回落幅度高于A组(均为P<0.01);(2)PCI术后48 h,D组的高敏C反应蛋白(hs-CRP)、白细胞介素6(IL-6)、丙二醛(MDA)和血管内皮生长因子(VEGF)水平均低于A、B和C组,超氧化物歧化酶(SOD)和一氧化氮(NO)水平均高于A、B和C组(均为P<0.001);B、C组的hs-CRP、IL-6、MDA和VEGF水平均低于A组,SOD和NO水平均高于A组(均为P<0.001);(3)PCI术后12 h和48 h,D组的高敏心肌肌钙蛋白I(hs-cTnI)水平均低于A、B和C组,B、C组的hs-cTnI水平均低于A组(均为P<0.001);(4)PCI术后1个月和12个月,D组的左心室射血分数(LVEF)水平均高于A、B和C组,B、C组的LVEF水平均高于A组(均为P<0.001);(5)PCI术后12个月内,4组患者的MACE发生率无统计学差异(χ^(2)=4.396,P=0.22)。结论单纯尼可地尔或RIPostC在PCI中均具有改善心肌灌注、拮抗氧化应激、抑制炎症反应、改善血管内皮、保护心肌细胞和改善心功能等作用,尼可地尔联合RIPostC的心肌保护作用明显优于单纯尼可地尔或RIPostC,联用具有协同、叠加效果。Objective To investigate the myocardial protective effect of nicorandil combined with remote ischemic post-conditioning(RIPostC)on acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).Methods This was a single-center,prospective,randomized controlled study.A total of 208 STEMI patients who received PCI in the Department of Cardiology,Jiaozuo People’s Hospital Affiliated to Xinxiang Medical College were included from January 2018 to September 2021.Patients were randomly divided into 4 groups according to the number table method:Group A(52 cases):routine PCI;Group B(52 cases):RIPostC+conventional PCI;Group C(52 cases):nicorandil+conventional PCI;Group D(52 cases):RIPostC+nicorandil+conventional PCI.Myocardial perfusion,arrhythmia,inflammatory response,vascular endothelial function,myocardial injury and cardiac function were detected before and after PCI.Major adverse cardiovascular events(MACE),including recurrent myocardial infarction,recurrent heart failure,cardiac shock,and cardiac death within 12 months,were recorded after operation.Results(1)The TIMI flow frame count(CTFC)corrected immediately after PCI,Curtis-Walker score 24 h after PCI and incidence of malignant arrhythmia were lower in group D than those in group A,the decrease of ST segment 2 h after operation was higher in group D than that in group A(all P<0.01).(2)48 h after PCI,the levels of high-sensitivity C-reactive protein(hs-CRP),interleukin 6(IL-6),malondialdehyde(MDA)and vascular endothelial growth factor(VEGF)were lower in group D than those in groups A,B and C(all P<0.001).The levels of superoxide dismutase(SOD)and nitric oxide(NO)were higher in group D than those in groups A,B and C(all P<0.001).The levels of hs-CRP,IL-6,MDA and VEGF were lower in groups B and C than those in group A,SOD and NO were higher in groups B and C than those in group A(all P<0.001).(3)At 12 h and 48 h after PCI,the level of high-sensitivity cardiac troponin I(hs-cTnI)was lower in group D than those in group

关 键 词：急性ST段抬高型心肌梗死 经皮冠状动脉介入 尼可地尔 远程缺血后适应 缺血再灌注损伤 

分 类 号：R542.22[医药卫生—心血管疾病]