远程缺血预处理联合经皮迷走神经刺激对ST段抬高型心肌梗死再灌注损伤的影响  

Effect of remote ischemic preconditioning combined with transcutaneous vagus nerve stimulation on reperfusion injury in ST-segment elevation myocardial infarction

作　　者：王凌[1] 庄志川 吴茵茵 杨金涛 柳丽丽 WANG Ling;ZHUANG Zhichuan;WU Yinyin;YANG Jintao;LIU Lili(Department of Cardiovascular Medicine,Quanzhou First Hospital Affiliated to Fujian Medical University,Quanzhou,Fujian,362000;Clinical Medicine Department of Fujian Medical University,Fuzhou,Fujian,350122;Department of Endocrinology,Jinjiang City Hospital in Fujian Province,Quanzhou,Fujian,362200)

机构地区：[1]福建医科大学附属泉州第一医院心血管内科,福建泉州362000 [2]福建医科大学临床医学部,福建福州350122 [3]福建省晋江市医院内分泌科,福建泉州362200

出　　处：《实用临床医药杂志》2023年第23期54-59,共6页Journal of Clinical Medicine in Practice

基　　金：福建省泉州市科技计划项目(2019C031R)。

摘　　要：目的探讨远程缺血预处理(RIPC)联合经皮迷走神经刺激(tVNS)对急性ST段抬高型心肌梗死(STEMI)再灌注损伤的影响。方法选取STEMI患者132例,在行经皮冠状动脉介入治疗(PCI)前随机分为对照组、tVNS组和联合组(RIPC联合tVNS)。132例患者共9例患者被排除,最终对照组纳入42例,tVNS组40例,联合组41例。比较3组72 h内肌酸激酶同工酶(CK-MB)的曲线下面积(AUC),再灌注后24 h内室性心律失常(VAs)情况。比较3组入院时及再灌注后24 h的白细胞介素-6(IL-6)、高迁移率族蛋白B1(HMGB1)、肿瘤坏死因子-α(TNF-α)水平和再灌注后7 d心脏彩超的左室射血分数(LVEF)。结果联合组72 h内CK-MB的AUC小于对照组,差异有统计学意义(P<0.05)。tVNS组及联合组再灌注后24 h内室性早搏、室性心动过速次数少于对照组,差异有统计学意义(P<0.05)。联合组再灌注后24 h的IL-6、HMGB1、TNF-α水平低于对照组,差异有统计学意义(P<0.05)。联合组再灌注后7 d LVEF高于照组,差异有统计学意义(P<0.05)。结论tVNS可显著降低STEMI患者行PCI治疗后VAs的发生率,但对再灌注炎症标志物水平、心肌梗死面积以及急性期左室收缩功能方面的改善效果不显著。tVNS联合RICP治疗在上述指标方面均能产生明显获益。Objective To investigate effect of remote ischemic preconditioning(RIPC)combined with transcutaneous vagus nerve stimulation(tVNS)on reperfusion injury in ST-segment elevation myocardial infarction(STEMI).Methods A total of 132 STEMI patients were selected,and were randomly divided into control group,tVNS group and combined group(RIPC combined with tVNS)before percutaneous coronary intervention(PCI).A total of 9 of the 132 patients were excluded,including 42 in the control group,40 in the tVNS group,and 41 in the combination group.The area under the curve(AUC)of creatine kinase isoenzyme(CK-MB)within 72 h and the ventricular arrhythmia(VAs)within 24 h after reperfusion were compared among the three groups.The levels of interleukin-6(IL-6),high mobility group protein B1(HMGB1),tumor necrosis factor-α(TNF-α)and left ventricular ejection fraction(LVEF)of the three groups were compared at admission and 24 h after reperfusion.Results The AUC of CK-MB in the combination group was significantly lower than that in the control group within 72 h(P<0.05).The total number of premature ventricular beats and the number of ventricular tachycardia in the tVNS group and combined group were significantly lower than those in the control group within 24 h after reperfusion(P<0.05).The levels of IL-6,HMGB1 and TNF-αin the combination group were significantly lower than those in the control group 24 h after reperfusion(P<0.05).LVEF in the combination group was significantly higher than that in the light group at 7 days after reperfusion(P<0.05).Conclusion The tVNS significantly reducs the incidence of VAs after PCI in STEMI patients,but has little effect on the level of reperfusion inflammatory markers,myocardial infarction size,and acute left ventricular systolic function.The tVNS combined with RICP can produce significant benefits in the above indexes.

关 键 词：经皮迷走神经刺激 经皮冠状动脉介入治疗 远程缺血预处理 急性ST段抬高型心肌梗死 再灌注损伤 

分 类 号：R714.252[医药卫生—妇产科学] R542.2[医药卫生—临床医学] R61