尼可地尔联合乌司他丁对老年急性心肌梗死患者心肌的保护作用  

Effects of Nicorandil combined with Ulinastatin on postoperative myocardial protection in elderly patients with AMI

作　　者：宣学习 张宇[1] 张传西 赵育洁 XUAN Xuexi;ZHANG Yu;ZHANG Chuanxi;ZHAO Yujie(Department of Cardiology,The Seventh People's Hospital of Zhengzhou,Zhengzhou,450000,China)

机构地区：[1]郑州市第七人民医院心血管内科,郑州450000

出　　处：《临床心血管病杂志》2024年第11期901-906,共6页Journal of Clinical Cardiology

基　　金：2023年度河南省医学科技攻关计划联合共建项目(No:LHGJ20230738)。

摘　　要：目的:观察尼可地尔联合乌司他丁在老年急性心肌梗死(AMI)患者中的应用效果,并基于术后心肌保护、ERK信号通路探究其作用机制。方法:选取2020年1月—2023年3月我院老年AMI患者100例。对照组采取乌司他丁治疗,观察组采取尼可地尔联合乌司他丁治疗,每组50例。观察两组疗效、不良心血管事件及治疗前后心功能[左室射血分数(LVEF)、每搏输出量(SV)、心排血量(CO)]、心肌损伤[可溶性肿瘤坏死因子样凋亡弱诱导因子(sTWEAK)、弗林蛋白酶(Furin)、中性粒细胞/淋巴细胞比值(NLR)]、氧化应激[超氧化物歧化酶(SOD)、醌氧化还原酶-1(NQO-1)、丙二醛(MDA)、髓过氧化物酶(MPO)]及细胞外调节蛋白激酶(ERK)信号通路表达。结果:观察组总有效率94.00%,高于对照组78.00%(P<0.05);治疗3、7 d后观察组LVEF、CO、SV水平高于对照组(P<0.05);治疗3、7 d后观察组sTWEAK、Furin、NLR水平低于对照组(P<0.05);治疗3、7 d后观察组MDA、MPO水平低于对照组,SOD、NQO-1水平高于对照组(P<0.05);治疗3、7 d后观察组Bad mRNA、ERK mRNA表达低于对照组(P<0.05);观察组不良心血管事件发生率4.00%,与对照组14.58%相比,无显著差异。结论:尼可地尔联合乌司他丁能有效降低老年AMI患者氧化应激损伤,改善心功能,并可通过ERK信号通路调控发挥心肌保护作用,疗效确切。Objective To observe the effect of Nicorandil combined with Ulinastatin in elderly patients with acute myocardial infarction(AMI), and explore its mechanism based on postoperative myocardial protection and ERK signaling pathway.Methods The 100 elderly patients with AMI in our hospital from January 2020 to March 2023 were selected. Control group was treated with Ulinastatin, and observation group was treated with Nicorandil combined with Ulinastatin, with 50 cases in each group. The efficacy, adverse cardiovascular events, cardiac function [left ventricular ejection fraction (LVEF), stroke output (SV), cardiac output (CO)], myocardial injury [soluble tumor necrosis faction-like weak apoptotic factor (sTWEAK), Furin, neutrophil-lymphocyte ratio (NLR)] and oxidation stress[superoxide dismutase (SOD), quinone oxidoreductase-1 (NQO-1), malondialdehyde (MDA), myeloperoxidase (MPO)]and extracellular regulatory protein kinase (ERK) signaling pathway expression of the two groups were observed.Results The total effective rate of observation group was 94.00%, which was higher than that of control group 78.00%(P < 0.05). The levels of LVEF, CO and SV in observation group were higher than those in control group after 3 and 7 days of treatment(P < 0.05);The levels of sTWEAK, Furin and NLR in the observation group were lower than those in the control group after 3 and 7 days of treatment(P < 0.05). After 3 and 7 days of treatment, the levels of MDA and MPO in observation group were lower than those in control group, and the levels of SOD and NQO-1 were higher than those in control group(P < 0.05). The expressions of Bad mRNA and ERK mRNA in the observation group were lower than those in the control group after 3 and 7 days of treatment(P < 0.05);The incidence of adverse cardiovascular events in the observation group was 4.00%, which had no significant difference compared with 14.58% in the control group.Conclusion Nicorandil combined with Ulinastatin can effectively reduce oxidative stress damage in elderly patients with AMI, i

关 键 词：乌司他丁 急性心肌梗死 老年 尼可地尔 ERK信号通路 

分 类 号：R542.2[医药卫生—心血管疾病]