尼可地尔联合替格瑞洛或氯吡格雷对行经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者炎性因子水平的影响及ST段回落相关因素分析  

Effect of nicorandil combined with ticagrelor or clopidogrel in STEMI and prognosis factors of ST pa-tients undergoing PCI

作　　者：杜垒 李泽浦 杨南华 杨胜勇 Du Lei;Li Zepu;Yang Nanhua;Yang Shengyong(Department of Cardiology,Shanghai Renhe Hospital,Shanghai 200341,China;Department of Cardiology,Shanghai Second Rehabilitation Hospital,Shanghai 201900,China)

机构地区：[1]上海仁和医院心内科,上海200341 [2]上海市第二康复医院心脏科,上海201900

出　　处：《中国药物与临床》2024年第8期509-513,共5页Chinese Remedies & Clinics

摘　　要：目的探索尼可地尔联合替格瑞洛或氯吡格雷对行经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者炎性因子水平的影响及ST段回落相关因素。方法回顾性分析2021年6月至2023年6月在上海仁和医院接受PCT治疗的182例STEMI患者作为研究组,在常规治疗基础上进行尼可地尔联合替格瑞洛或氯吡格雷治疗,另在同一时间内选取上海市第二康复医院接受PCT治疗的180例STEMI患者作为对照组,进行常规治疗。比较2组左心室射血分数(LVEF)、左心室收缩末内径(LVDs)、左心室舒张末内径(LVDd)、心肌肌钙蛋白(cTnI)、肌酸激酶同工酶(CK-MB)、肿瘤坏死因子(TNF)-α、超敏C反应蛋白(hs-CRP)、白细胞介素(IL)-6。根据研究组患者ST段回落情况分为ST段回落良好组(回落率>50%,129例),ST段回落不良组(回落率≤50%,53例),经二元Logistic回归分析影响患者ST段回落的独立因素。结果研究组LVEF、LVDs、LVDd、cTnI、CK-MB、TNF-α、hs-CRP、IL-6改善情况优于对照组(P<0.05)。经二元Logistic回归分析,有糖尿病史、术前TIMI血流0~1级、梗死血管为前降支是影响STEMI患者PCI术后ST段回落的危险因素(P<0.05)。结论尼可地尔联合氯吡格雷或替格瑞洛对行PCI的STEMI患者效果显著,不仅改善其炎症因子水平和心功能,还使术后ST段回落率较高,改善患者的预后。Objective To explore the effects of nicorandil combined with ticagrelor or clopidogrel on in-flammatory factors and acute ST elevation myocardial infarction(STEMI)patients with percutaneous coronary inter-vention(PCI).Methods A total of 182 STEMI patients treated with PCT at Shanghai Renhe Hospital from June 2021 to June 2023 were retrospectively analyzed.As a study group,they were treated with nicodil combined with ticagrelor or clopidogrel in addition to conventional treatment.In addition,180 STEMI patients who received PCT treatment in Shanghai Second Rehabilitation Hospital were selected as the control group for routine treatment.Compare two groups of LVEF,LVDs,LVDd,cTnI,CK-MB,TNF-α,hs-CRP,and IL-6.At the same time,according to the reference group of ST decline,patients were divided into two groups,that is,the group with good ST decline(decline rate>50%,n=129),and the group with bad ST decline(decline rate≤50%,n=53),the independent fac-tors affecting the decline of ST by binary Logistic regression analysis.Results The improvement of LVEF,LVDs,LVDd,cTnI,CK-MB,TNF-α,hs-CRP and IL-6 in the reference group was better than in the control group(P<0.05).After binary Logistic regression analysis,a history of diabetes,preoperative TIMI flow grade 0~1,and infarct vessels of the an-terior descending branch were independent factors affecting the ST segment decline after PCI in STEMI patients(P<0.05).Conclusion Nicorandil combined with clopidogrel or ticagrelor has a significant effect on STEMI pa-tients undergoing PCI,not only improving their levels of inflammatory factors and cardiac function,but also in-creasing the postoperative ST segment resolution rate and improving the prognosis of patients.

关 键 词：尼可地尔 替格瑞洛 氯吡格雷 经皮冠状动脉介入治疗 ST段抬高型心肌梗死 炎性因子 ST段回落 

分 类 号：R542.22[医药卫生—心血管疾病]