门冬胰岛素注射液强化治疗对急性心肌梗死伴应激性高血糖患者经皮冠状动脉介入术后心肌微灌注及无复流现象的影响研究

背景急性心肌梗死(AMI)伴应激性高血糖(SHG)患者经皮冠状动脉介入术(PCI)后心肌微灌注及复流现象可能会受到一定影响,而进行SHG强化治疗对改善患者预后具有重要意义。目的探讨门冬胰岛素注射液强化治疗对AMI伴SHG患者PCI后心肌微灌注及无复流现象的影响。方法选取河北北方学院附属第二医院2016年4月—2018年6月收治的AMI伴SHG患者106例,按照随机数字表法分为对照组(n=53)和观察组(n=53)。两组患者均采用PCI治疗,术后对照组患者采用常规降糖药物治疗,观察组患者在对照组基础上给予门冬胰岛素注射液强化治疗。比较两组患者术前及术后1周血清白介素18(IL-18)、白介素16(IL-16)水平,术后1周心肌微灌注指标(包括心肌显像峰值强度、曲线上升至平台期斜率、峰浓度、达峰时间及心肌微灌注血流量),术前、术后1周及术后1个月心功能指标〔包括左心室舒张末容量指数(LVEDVI)、左心室收缩末容量指数(LVSVI)、左心室射血分数(LVEF)〕,术后1年无复流现象、主要不良心血管事件(MACE)发生情况。结果两组患者术前血清IL-18、IL-16水平比较,差异无统计学意义(P>0.05);观察组患者术后1周血清IL-18、IL-16水平低于对照组(P<0.05)。观察组患者术后1周心肌显像峰值强度、曲线上升至平台期斜率、峰浓度及心肌灌注血流量高于对照组,心肌显像达峰时间短于对照组(P<0.05)。两组患者术前LVEDVI、LVSVI、LVEF及术后1周、1个月LVEF比较,差异无统计学意义(P>0.05);观察组患者术后1周、1个月LVEDVI、LVSVI低于对照组(P<0.05)。观察组患者术后1年无复流现象发生率低于对照组(P<0.05)。两组患者术后1年MACE发生率比较,差异无统计学意义(P>0.05)。结论门冬胰岛素注射液强化治疗可有效减轻AMI伴SHG患者PCI后炎性反应,改善患者心肌微灌注及心功能,减少无复流现象发生,且安全性高。

Impact of Insulin Aspart Injection Intensive Treatment on Myocardial Microperfusion and No Reflow after Percutaneous Coronary Intervention in Acute Myocardial Infarction Patients Complicated with Stress Hyperglycemia

Background Acute myocardial infarction(AMI)patients complicated with stress hyperglycemia(SHG)after percutaneous coronary intervention(PCI)can affect myocardial microperfusion and no reflow,and intensive treatment of SHG for this situation is of great significance to the prognosis of patients.Objective To discuss impact of insulin aspart injection intensive treatment on myocardial microperfusion and no reflow after PCI in AMI patients complicated with SHG.Methods A total of 106 AMI patients complicated with SHG admitted to the Second Affilated Hospital of Hebei North University from April 2016 to June 2018,and they were divided into control group(n=53)and observation group(n=53)according to random number table method.Both groups received PCI,patients in control group were treated with conventional hypoglycemic scheme,and patients in observation group were given insulin aspart injection intensive treatment based on control group.Serum levels of IL-18 and IL-16 before operation and 1 week after operation,myocardial microperfusion indexes(including peak intensity of myocardial imaging,slope of curve rising to plateau,peak concentration,peak time and myocardial microperfusion blood flow)1 week after operation,cardiac function indexes(including LVEDVI,LVSVI and LVEF)before operation and 1 week,1 month after operation,incidence of no reflow and MACE 1 year after operation were compared between the two groups.Results There was no significant difference in serum levels of IL-18 or IL-16 between the two groups before operation(P>0.05);serum levels of IL-18 and IL-16 in observation group were lower than those in control group 1 week after operation(P<0.05).Peak intensity of myocardial imaging,slope of curve rising to plateau in observation group were larger than those in control group,peak concentration and myocardial microperfusion blood flow in observation group were higher than those in control group,peak time of myocardial imaging in observation group was shorter than that in control group(P<0.05).There were no significant difference in LVEDVI,LVSVI,LVEF before operation or LVEF 1 week,1 month after operation between the two groups(P>0.05);LVEDVI,LVSVI in observation group were lower than those in control group 1 week,1 month after operation(P<0.05).Incidence of no reflow in observation group was lower than that in control group 1 year after operation(P<0.05).There was no significant difference in incidence of MACE between the two groups 1 year after operation(P>0.05).Conclusion Insulin aspart injection intensive treatment can effectively reduce inflammatory response of AMI patients complicated with SHG after PCI,improve myocardial microperfusion and cardiac function of patients,and reduce incidence of no reflow,and with retively high safety.