替罗非班应用于急诊经皮冠状动脉介入治疗对急性心肌梗死患者心肌灌注和内皮功能的影响

目的探讨急诊经皮冠状动脉介入治疗（PCI）术中冠状动脉内应用替罗非班对急性心肌梗死（AMI）患者冠状动脉血流和内皮功能的影响。 方法选择2013年1月至2015年6月在泰安市中心医院心内科接受急诊PCI治疗的AMI患者共114例，用随机数字表法分为替罗非班组（58例）及对照组（56例）。替罗非班组冠状动脉内注射替罗非班10 μg / kg，继之以0.075 μg·kg^-1·min^-1静脉滴注24至48 h，对照组不应用替罗非班。根据冠状动脉造影图像观察两组患者TIMI血流分级情况，并应用酶联免疫吸附法检测两组PCI治疗术前及术后24 h、72 h的可溶性细胞黏附因子1（sICAM-1）、可溶性血管细胞黏附分子1（sVCAM-1）、内皮损伤标志物血管性血友病因子（vWF）、炎症反应标志物超敏C反应蛋白（hs-CRP）水平并予以分析。 结果替罗非班组心肌梗死溶栓治疗（TIMI）3级血流比例显著高于对照组，差异有统计学意义（79.3% vs. 50%，χ² = 10.747，P = 0.001）。对照组与替罗非班组患者治疗前的sICAM-1、sVCAM-1、vWF、hs-CRP水平比较，差异均无统计学意义（P均> 0.05），替罗非班组患者治疗后24 h的sICAM-1（24.2 ± 2.3）μg / L vs.（37.1 ± 3.3）μg / L]、sVCAM-1（26.2 ± 2.9）μg / L vs.（43.1 ± 3.8）μg / L]、vWF（514 ± 135）U / L vs.（588 ± 126）U/L]水平均低于对照组（P均< 0.05），替罗非班组患者治疗后72 h的sICAM-1（22.4 ± 1.8）μg / L（32.4 ± 2.5）μg / L]、sVCAM-1（23.7 ± 2.2）μg/L vs.（38.9 ± 2.6）μg /L]、vWF（586 ± 145）U / L vs. （678 ± 144）U / L]、hs-CRP（7.2 ± 2.7）mg / L vs.（8.5 ± 3.5）mg/L]水平均明显低于对照组（P均< 0.05）。 结论AMI患者急诊PCI冠状动脉内注射替罗非班可显著改善靶血管前向血流TIMI分级和血管内皮功能。

Effect of intracoronary tirofiban on myocardial reperfusion and endothelial function in patients with acute myocardial infarction undergoing percutaneous coronary intervention

ObjectiveTo investigate the effect of intracoronary tirofiban on myocardial reperfusion and endothelial function in patients with acute myocardial infarction (AMI) undergoing emergency percutaneous coronary intervention (PCI). MethodsTotally 114 patients with AMI treated by emergency PCI were divided randomly into the tirofiban group (58 cases) and control group (56 cases). In the tirofiban group, tirofiban was administered intravenously as a bolus injection at a dose of 10 μg/kg followed by intravenous infusion at 0.075 μg·kg^-1·min^-1 for 24 to 48 hours, while patients in the control group did not took tirofiban treatment. Thrombolysis in myocardial infarction (TIMI) flow grade was assessed by coronary angiography picture at the end of PCI. The levels of soluble intercellular adhesion molecule-1 (sICAM-1), soluble vascular cell adhesion molecule-1 (sVCAM-1), von Willeband factor (vWF) and high-sensitivity C-reactive protein (hs-CRP) were measured by enzyme-linked immunosorbent assay (ELISA). Serial venous blood samples were obtained before and 1 day after PCI. ResultsCompared with the control group, the proportion of TIMI grade 3 flow in the tirofiban group was significantly higher (79.3% vs 50.0%, χ² = 10.747, P < 0.05). There were no statistical differences noted in the levels of sICAM-1, sVCAM-1, vWF, hs-CRP between the two groups before tirofiban treatment (all P > 0.05). 24 h after the treatment, the levels of sICAM-1(24.2 ± 2.3) μg/L vs. (37.1 ± 3.3) μg/L], sVCAM-1(26.2 ± 2.9) μg/L vs. (43.1 ± 3.8) μg/L]、vWF(514 ± 135) U/L vs.(588 ± 126) U/L] in the tirofiban group were significantly lower than those in the control group (all P < 0.05); 72 h after the treatment, the levels of sICAM-1 (22.4 ± 1.8) μg/L vs. (32.4 ± 2.5) μg/L], sVCAM-1(23.7 ± 2.2) μg/L vs. (38.9 ± 2.6) μg/L], vWF (586 ± 145) U/L vs. (678 ± 144) U/L], hs-CRP (7.2 ± 2.7) mg/L vs. (8.5 ± 3.5) mg/L] in the tirofiban group were significantly lower than those in the control group (all P < 0.05). ConclusionIntracoronary injections of tirofiban to AMI patients during emergency PCI could improve myocardial tissue perfusion and endothelial function.