瑞替普酶联合磷酸肌酸钠治疗急性ST段抬高型心肌梗死的近期临床疗效

目的观察重组人组织型纤溶酶原激酶衍生物瑞替普酶(rPA)联合磷酸肌酸钠治疗急性ST段抬高型心肌梗死的疗效及安全性。方法选取70例符合溶栓治疗指征的急性ST段抬高型心肌梗死患者,随机分为常规溶栓组和磷酸肌酸钠组,每组各35例;磷酸肌酸钠组于溶栓治疗同时给予磷酸肌酸钠治疗。分别于治疗前、治疗后24h检测两组患者血浆肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)以及超氧化物歧化酶(SOD)活力;所有入选患者2周时行心脏彩超检查,采用Simpson法测定和计算左心室舒张末期内径、左心室收缩末期内径、左心室射血分数;观察两组治疗后2周内心血管不良事件的发生率。结果磷酸肌酸钠组血管再通率高于常规溶栓组(65.7%vs 62.8%),但两组比较差异无统计学意义(P>0.05)。与溶栓治疗前比较,两组治疗后血浆CK-MB、cTnI、SOD较治疗前显著升高,且SOD活性的升高低于CK-MB、cTnI升高的幅度(P<0.05),磷酸肌酸钠组治疗后血浆CK-MB、cTnI升高的幅度显著低于常规溶栓组,SOD活性显著高于常规溶栓组(P<0.05)。常规溶栓组左心室舒张末期内径、左心室收缩末期内径均高于磷酸肌酸钠组,左心室射血分数低于磷酸肌酸钠组。磷酸肌酸钠组较常规溶栓组梗死后心绞痛发生率、再发心肌梗死率、恶性心律失常发生率显著下降(P<0.05);而心源性休克及病死率和出血发生率的两组比较,差异无统计学意义(P>0.05)。结论磷酸肌酸钠对心肌梗死的缺血/再灌注损伤心肌有保护作用,rPA溶栓联合磷酸肌酸钠治疗急性ST段抬高型心肌梗死,能较好的降低冠状动脉再通后近期并发症的发生。

Short-term Clinical Effect about rPA Combined with Creatine Phosphate Sodium in the Treatment of Acute ST Segment Elevation Myocardial Infarction

Objective To observe the efficacy and safety of the recombinant human tissue type plas- minogen kinase derivative（rPA） combined with creatine phosphate sodium in the treatment of acute ST seg- ment elevation myocardial infarction. Methods A total of 70 acute ST segment elevation myocardial infarc- tion patients in compliance with thrombolytic therapy indications were randomly divided into conventional thrombolytic therapy group and creatine phosphate sodium group ,35 cases in each group. The creatine phos- phate sodium was used while the thrombolytic therapy was given in the creatine phosphate group. The activity of plasma cardiac troponin I （ cTnI）, creatine kinase isoenzyme （ CK-MB ） and superoxide dismutase （ SOD ） were detected in two groups before and 24 hours after treatment respectively. Echocardiography was examined in all patients by 2 weeks. Left ventricular end diastolic diameter, left ventricular end systolic diameter and left ventricular ejection fraction were determined and calculated by Simpson method. The occurrence of cardi- ovascular adverse event within 2 weeks in the 2 groups was observed. Results The recanalization rate in creatine phosphate sodium group was higher than that in routine therapy group（65.7% vs 62.8% ） ,with no significant differences between the two groups （ P 〉 0.05 ）. The plasma levels of CK-MB, cTnI and SOD were higher than that before treatment,the plasma level increase of SOD was lower than that of CK-MB and cTnI （ P 〈 0.05 ）. The increased degree of plasma CK-MB and cTnI in creatine phosphate sodium group were significantly lower than that of the routine therapy group, the activity of SOD was significantly higher than that of the routine therapy group（ P 〈 0.05 ）. The left ventricular end diastolic diameter and left ventricular end systolic diameter in the routine therapy group were higher than those of the creatine phosphate sodium group, left ventricular ejection fraction was lower than that of the creatine phosphate sodium group. The incidence of infarction angina, myocardial reinfarction and malignant arrhythmia in the creatine phosphate sodium group were significantly decreased than those of the routine thrombolytic therapy group （ P 〈 0.05 ） ; there were no significant differences between the two groups on the incidence of ardiogenic shock, mortality and bleeding （ P 〉 0.05 ）. Conclusion Creatine phosphate sodium has protective effect on myocardial ischemia/reperfu- sion injury in myocardial infarction;rPA combined with creatine phosphate sodium could reduce the occur- rence of short-term complications after coronary artery recanalization in the treatment of acute ST segment elevation myocardial infarction.