阿卡波糖对冠心病糖耐量减低患者经皮冠状动脉介入治疗后心肌灌注的影响及其机制

目的观察阿卡波糖治疗冠状动脉粥样硬化性心脏病(冠心病)糖耐量减低(impaired glucose tolerance,IGT)行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后完全血运重建患者的血糖、血脂、血管内皮生长因子(vascular endothelial growth factor,VEGF)和心肌灌注的变化,探讨其改善心肌灌注的可能机制。方法选择2017年1月至2018年3月河北大学附属医院收治的冠心病合并IGT,PCI治疗完全血运重建,术后6个月均复查冠状动脉造影(coronary arterial angiography,CAG)示无支架内血栓、再狭窄、新发病变的患者123例。所有入组患者均严格遵循糖尿病饮食、运动控制、监测血糖并按相关指南坚持抗栓、降脂和降压等治疗。将入组患者按照随机化原则分为试验组:A组为阿卡波糖低剂量(50 mg/次,3次/d)、B组为阿卡波糖高剂量组(100 mg/次,3次/d);对照组(C组为)安慰剂。观察3组患者的血糖、血脂、VEGF、心肌灌注显像变化。结果3组患者基线血糖、血脂、VEGF、心肌灌注显像等比较,差异无统计学意义(P>0.05)。3组患者复查CAG均未见支架内血栓、再狭窄、新发病变。3组患者治疗前、后血脂比较,差异无统计学意义(P>0.05)。治疗后,阿卡波糖低剂量、高剂量治疗组患者血糖、VEGF较对照组患者的降低,心肌灌注显像改善,差异具有统计学意义(P<0.05),且高剂量组较低剂量组疗效更显著(P<0.05)。结论阿卡波糖可降低冠心病合并IGT患者行PCI治疗后的血糖、血浆VEGF因子浓度,抑制血管内皮过度增生和改善心肌微循环,改善心肌灌注,从而降低主要不良心血管事件的发生。

Effect of acarbose on myocardial perfusion in patients suffering from coronary heart disease complicated impaired glucose tolerance after percutaneous coronary intervention and its mechanism

Objectives To observe whether acarbose administration could cause changes in blood glucose,blood lipids,vascular endothelial growth factor(VEGF)and myocardial perfusion in patients suffering from coronary artery disease(CHD)complicated impaired glucose tolerance(IGT)but had achieved complete revascularization after percutaneous coronary intervention(PCI),and to explore its probable mechanism.Methods Totally 123 patients suffering from CHD complicated IGT but had achieved complete revascularization after a PCI were selected from January 2017 to March 2018 in Affiliated Hospital of Hebei University.Six months after PCI,the 123 patients performed coronary arteri⁃al angiography(CAG),among whom,blood clots inside the stent(s),renarrowing or other new lesions could not be found.All the patients in the study strictly followed a regimen of diabetic diet and exercise.Their blood glucose was being monitored.They were also on anti clotting,cholesterol lowering and blood pressure lowering treatment.The patients were divided into three groups randomly:group A on a low dose of acarbose(50 mg/time,3 times/d),group B on a high dose of acarbose(100 mg/time,3 times/d)and group C on placebo.Changes of concentration in blood glucose,blood lipid,vascular endothelial growth factor(VEGF)and myocardial perfusion in the three groups were observed.Results Concentrations of blood glucose,blood lipid,VEGF and level of blood flow shown in myocardial perfusion im⁃aging were not statistically significant among the three groups before treatment(P>0.05).No blood clots inside the stent(s),restenosis and new lesions were found in CAG among the three groups before treatment.There were no significant changes in blood lipid concentrations before and after treatment among the three groups(P>0.05).However,compared to control group,concentrations of blood glucose and VEGF decreased and myocardial perfusion improved in both low and high dose of acarbose groups,among which the differences were statistically significant(P<0.05).And the therapeutic effect of high dose was more significant than that of low dose(P<0.05).Conclusions Acarbose administration can reduce concentrations of blood glucose and plasma VEGF,inhibit vascular endothelial hyperplasia and improve myocardial perfu⁃sion in patients with CHD complicated IGT after PCI,thereby reducing the risk of major adverse cardiovascular events.