早期应用替罗非班对急诊ST段抬高型心肌梗死患者经皮冠状动脉介入术后机体状况的影响

目的探讨早期应用替罗非班对急诊ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入术(PCI)后炎症反应、血管造影和临床结果的影响。方法将123例STEMI行PCI患者分为观察组(n=65)和对照组(n=58)。观察组应用替罗非班,对照组未应用替罗非班。比较2组患者入院时和治疗3 d后血清超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)和降钙素原(PCT)水平;比较2组患者术后TIMI 3级血流恢复率、校正TIMI帧数及术后90 min的ST段回落高于75%、30 d主要不良心脏事件(MACE)和住院期间出血事件的发生率;对MACE的影响因素进行单因素和多因素分析。结果治疗3 d后,观察组hs-CRP、IL-6、PCT低于对照组,差异均有统计学意义(P<0.05)。与对照组相比,观察组术后梗死相关血管的TIMI 3级血流恢复率较高,校正TIMI帧数较低,术后90 min ST段回落高于75%的发生率较高,30 d的MACE发生率较低,差异均有统计学意义(P<0.05)。单因素分析显示,MACE组患者糖尿病患病率、Killip心功能分级和血肌酐高于非MACE组,收缩压低于非MACE组,差异有统计学意义(P<0.05)。多因素分析显示,入院时心功能分级、收缩压和早期应用替罗非班是MACE的独立影响因素(P<0.05)。结论早期应用替罗非班可减轻急诊STEMI行PCI患者术后炎症反应,改善血管造影和临床结果,且是MACE的独立影响因素。

Effect of early application of tirofiban on body status of patients with emergency ST segment elevation myocardial infarction after percutaneous coronary intervention

Objective To investigate the effect of early application of tirofiban on the inflammatory response,angiography and clinical outcome of patients with emergency ST segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods Totally 123 STEMI patients with PCI were divided into observation group(n=65)and control group(n=58).The observation group was treated with tirofiban,and the control group was not treated with tirofiban.The levels of serum high sensitivity C-reactive protein(hs-CRP),interleukin-6(IL-6)and procalcitonin(PCT)were compared between the two groups at hospital admission and 3 days after treatment.The recovery rate of TIMI grade 3 blood flow,corrected TIMI frame number,incidence rates of ST segment resolution higher than 75%at 90 min after operation,major adverse cardiac events(MACE)at 30 d and bleeding events during hospitalization were compared between the two groups.The influencing factors of MACE were analyzed by univariate and multivariate analysis.Results After 3 days of treatment,hs-CRP,IL-6 and PCT in the observation group were significantly lower than those in the control group(P<0.05).Compared with the control group,the recovery rate of TIMI grade 3 blood flow of infarction-related vessels in the observation group was significantly higher,the number of corrected TIMI frames was significantly lower,the incidence of ST segment resolution higher than 75%at 90 min after operation was significantly higher,and the incidence rate of MACE at 30 d was significantly lower(P<0.05).Univariate analysis showed that the prevalence rate of diabetes,Killip cardiac function classification and serum creatinine in the MACE group were significantly higher than those in the non-MACE group,and the systolic blood pressure was significantly lower than that in the non-MACE group(P<0.05).Multivariate analysis showed that cardiac function classification at admission,systolic blood pressure and early application of tirofiban were independent influencing factors of MACE(P<0.05).Conclusion Early application of tirofiban can reduce the inflammatory reaction,improve the angiographic and clinical results of emergency STEMI patients with PCI,and it is also an independent factor of MACE.