急性心肌梗死患者溶栓后早期PCI的临床疗效及血清NGF、COX-2水平变化

目的探讨急性心肌梗死患者静脉溶栓后早期行经皮冠状动脉介入术(PCI)的临床疗效及血清神经生长因子(NGF)和环氧化酶-2(COX-2)水平的影响。方法收集2018年1月~2019年12月驻马店中心医院接诊的急性ST段抬高型心肌梗死(STEMI)患者154例,分为溶栓后早期PCI组(n=70例)和直接PCI(pPCI)组(n=84例)。溶栓后早期PCI组接受重组人尿激酶原(rhPro-UK)静脉溶栓12 h内拟行早期PCI。比较两组患者PCI后治疗结局以及血清肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白(cTnI)、NGF、COX-2峰值以及术后7 d心功能改善情况。结果溶栓后早期PCI组PCI后TIMI心肌灌注分级(TMPG)3级者比例均高于pPCI组,同时PCI后校正TIMI血流计帧数(CTFC)帧数、NGF、COX-2、CK-MB峰值亦低于pPCI组,另外PCI后7 d和入院时左室射血分数(LVEF)差值和左室舒张末期内径(LVEDd)差值均高于pPCI组,差异有统计学意义(P<0.05)。经Pearson相关性分析,PCI后NGF和COX-2峰值程正相关性,而且两者分别与CK-MB峰值、cTnI峰值、术后7 d与术前的LVEDd差值呈正相关性,而与术后7 d与术前的LVEF差值则呈负相关性(P<0.05)。两组患者院内死亡率和出血并发症发生率比较无统计学差异(P>0.05)。结论STEMI患者采用静脉注射rhPro-UK溶栓后早期PCI可在短时间内改善患者的心功能,院内出血事件发生率较低,而且PCI后血清NGF、COX-2、CK-MB峰值亦低于pPCI患者。

Clinical efficacy of early PCI and changes in serum NGF and COX-2 levels in patients with acute myocardial infarction after thrombolysis

Objective To explore the effect of early percutaneous coronary intervention(PCI)after thrombolysis on the treatment of acute myocardial infarction and serum nerve growth factor(NGF),cyclooxygenase-2(COX-2)levels.Methods A total of 154 patients with acute ST-segment elevation myocardial infarction(STEMI)were enrolled from January 2018 to December 2019,and divided into early PCI after thrombolysis group(n=70)and primary PCI(pPCI)group(n=84).Patients in early PCI after thrombolysis group were received recombinant prourokinase(rhPro-UK)thrombolysis therapy and then immediately transferred to early PCI,while patients in pPCI group were treated with primary PCI.The treatment outcome and serum CK-MB,cTnI,NGF,COX-2 levels after PCI,left ventricular function at 7d were compared.Results After PCI,the proportion of patients with TIMI myocardial perfusion grade(TMPG)grade 2~3 in early PCI after thrombolysis group was higher than that in pPCI group,while the corrected TIMI frame count(CTFC)and peak values of CK-MB,NGF,COX-2 levels were lower,besides,the differences of left ventricular end-diastolic diameter(LVEDd)or left ventricular ejection fraction(LVEF)before and after PCI were also higher than pPCI group(P<0.05).Pearson analysis results showed that NGF peak value was positively related with COX-2 peak values(P<0.05),and the peak values of NGF,COX-2 levels were both closely related with CK-MB peak values,the differences of LVEDd or LVEF before and after PCI(P<0.05).There was no difference of incidence of bleeding events in hospital between early PCI after thrombolysis group and pPCI group(P>0.05).Conclusion Early PCI treatment after intravenous rhPro-UK thrombolysis in STEMI patients can improve the heart function of patients in a short time,and the incidence of bleeding in the hospital is relatively low,and the peaks of serum NGF,COX-2 and CK-MB after PCI are also Lower than pPCI patients..