别嘌呤醇改善急性心肌梗死患者再灌注后心房颤动的临床研究  

Allopurinol improves atrial fibrillation after reperfusion injury in patients with acute myocardial infarction

作　　者：钟佳琳 杨果 杨彦鹏[2] 邢扬 周月琴 肖骏 ZHONG Jialin;YANG Guo;YANG Yanpeng;XING Yang;ZHOU Yueqin;XIAO Jun(School of Medicine,Chongqing University,Chongqing,400044,China;Department of Cardiovascular,Chongqing Emergency Medical Center,Chongqing University Central Hospital;Department of Clinical Laboratory,Chongqing Emergency Medical Center,Chongqing University Central Hospital;Department of Neurology,Chongqing Emergency Medical Center,Chongqing University Central Hospital)

机构地区：[1]重庆大学医学院,重庆400044 [2]重庆大学附属中心医院、重庆市急救医疗中心心血管内科 [3]重庆大学附属中心医院、重庆市急救医疗中心检验科 [4]重庆大学附属中心医院、重庆市急救医疗中心神经内科

出　　处：《临床急诊杂志》2025年第3期169-174,共6页Journal of Clinical Emergency

基　　金：重庆市科卫联合医学科研项目(No:2023MSXM019);2022年重庆市中青年医学高端人才工作室建设经费资助(No:渝卫人[2023]10号);2023年重庆市公共卫生重点专科(学科)建设经费资助(No:渝卫办发[2023]81号);重庆市教委科技研究计划重大项目(No:KJZD-M202300103)。

摘　　要：目的:阐明氧化应激在急性心肌梗死后新发心房颤动中的核心作用,并评估别嘌呤醇预处理对心肌梗死再灌注后新发心房颤动及其心血管不良事件的潜在改善效果。方法:纳入106例接受急诊经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者,随机分配至别嘌呤醇治疗组(53例)和对照组(53例)。分别在术前、术后第1周和第4周对2组患者测定一系列生化指标,包括黄嘌呤氧化酶(XOD)、超氧化物歧化酶、活性氧(ROS)、高敏C反应蛋白(hs-CRP)、N末端脑利钠肽前体(NT-proBNP)、肌酸激酶同工酶(CK-MB)、血尿酸(UA)、肿瘤坏死因子α(TNF-α)、左心房前后径(LAD)、左心室射血分数(LVEF)及心房颤动的心电事件。同时,记录患者在治疗期间的所有主要不良心血管事件,包括心血管死亡、心肌梗死和卒中以及与别嘌呤醇治疗相关的不良事件。结果:2组患者血清学指标(XOD、ROS、hs-CRP、NT-proBNP、CK-MB、UA、TNF-α)均下降,且别嘌呤醇治疗组患者下降更显著(P<0.05)。与基线水平比较,2组患者LAD、LVEF差异无统计学意义,2组间LAD和LVEF比较差异也无统计学意义(P>0.05)。别嘌呤醇治疗组新发心房颤动、心脏性死亡和再发心肌梗死的比例较对照组明显降低(P<0.05)。结论:别嘌呤醇可减少ROS等的生成,降低氧化应激,从而改善心肌梗死后行血运重建的患者新发心房颤动的发生及减少心血管不良事件发生。Objective To investigate the important role of oxidative stress in new-onset atrial fibrillation(NOAF)after acute myocardial infarction,and to evaluate the potential improvement effect of allopurinol pretreatment on NOAF and cardiovascular adverse events after myocardial infarction reperfusion.Methods A total of 106 patients with acute ST segment elevation myocardial infarction who had undergone emergency percutaneous coronary intervention therapy were selected,and they were randomly divided into the allopurinol treatment group(53 cases)and the control group(53 cases).The levels of xanthine oxidase(XOD),superoxide dismutase,reactive oxygen species(ROS),high-sensitive C-reactive protein(hs-CRP),N-terminal pro brain natriuretic peptide(NT-proBNP),creatine kinase isoenzymes(CK-MB),blood uric acid(UA),tumor necrosis factor α(TNF-α)anterior,posterior diameter of the left atrium(LAD)and the left ventricular ejection fraction(LVEF)were determined,and the electrocardiogram events of atrial fibrillation were recorded preoperatively,postoperatively at one week,and at four weeks.Patients were also recorded for cardiovascular death,myocardial infarction,stroke,and all possible allopurinol-related adverse events throughout the treatment period.Results The serum indicators(XOD,ROS,hs-CRP,NT-proBNP,CK-MB,UA,TNF-α)of both groups of patients decreased,and the decrease was more significant in the allopurinol treatment group(P<0.05).Compared with baseline levels,there was no significant difference in LAD and LVEF between the two groups of patients,and there was also no significant difference in LAD and LVEF between the two groups(P>0.05).The proportion of newly diagnosed atrial fibrillation,cardiac death,and recurrent myocardial infarction in the allopurinol treatment group was significantly lower than that in the control group(P<0.05).Conclusion Allopurinol can reduce the generation of ROS and oxidative stress,thereby improving the occurrence of NOAF and reducing cardiovascular adverse events in patients with revascularization

关 键 词：急性心肌梗死 新发心房颤动 氧化应激 别嘌呤醇 

分 类 号：R542.22[医药卫生—心血管疾病]