半量瑞替普酶静脉溶栓对急性心肌梗死患者血流动力、循环内皮细胞及安全性的影响

目的　研究半量瑞替普酶静脉溶栓对急性心肌梗死（acute myocardial infarction，AMI）患者血流动力、循环内皮细胞（circulating endothelial cells，CEC）及安全性的影响。方法　收集2020年1月至2022年1月于延安大学附属医院就诊的AMI患者90例，根据治疗药物的不同分为对照组（尿激酶治疗）、研究组（半量瑞替普酶治疗），每组45例患者。研究组男27例，女18例，年龄（57.12±8.47）岁；对照组男29例，女16例，年龄（56.24±9.31）岁。检测两组患者心血管事件及并发症发生情况，于干预后0.5 h、1.0 h、1.5 h、2.0 h观察血管再通率，采用超声心动图检测两组患者血流动力学相关指标，Perooll法分离计数CEC，用放射免疫法测定内皮素-1（endothelin-1，ET-1）水平。采用t检验、χ²检验、Fisher确切概率法。结果　治疗前两组患者左心房平均压（mean left atrial pressure，mLAP）、肺动脉平均圧（mean pulmonary arterial pressure，mPAP）、平均左房室瓣压力差（malignant mitral valve prolapse，mMVP）水平对比差异均无统计学意义（均P>0.05），经过治疗后mLAP、mPAP、mMVP水平均降低（均P<0.05），且以研究组降低更为显著（均P<0.05）。治疗前两组患者血浆ET-1、CEC水平对比差异均无统计学意义（均P>0.05），在经过治疗后两组患者ET-1、CEC水平均降低（均P<0.05），且以研究组降低更为显著（均P<0.05）。研究组患者在不同时间的血管再通率均高于对照组［26.67%（12/45）比6.67%（3/45），35.56%（16/45）比13.33%（6/45），60.00%（27/45）比33.33%（15/45），77.78%（35/45）比51.11%（23/45）；均P<0.05］。研究组患者心血管事件的发生率以及并发症的产生率与对照组比较差异均无统计学意义（均P>0.05）。结论　半量瑞替普酶静脉溶栓可改善AMI患者的血流动力学，通过抑制CEC表达可改善血管内皮细胞损伤，且并发症发生率低，对于AMI的治疗具有一定的安全性。

Study on hemodynamics,circulating endothelial cells,and safety in patients with acute myocardial infarction treated by intravenous thrombolysis with half-dose reteplase

Objective　To study the effects of intravenous thrombolysis with half-dose reteplase on hemodynamics, circulating endothelial cells (CEC), and safety in patients with acute myocardial infarction (AMI). Methods　A total of 90 AMI patients admitted to Affiliated Hospital of Yan 'an University from January 2020 to January 2022 were collected and were divided into a control group (urokinase treatment) and a study group (half-dose reteplase treatment) according to different treatment drugs, with 45 patients in each group. There were 27 males and 18 females in the study group, aged (57.12±8.47) years; there were 29 males and 16 females in the control group, aged (56.24±9.31) years. The incidences of cardiovascular events and complications in the two groups were detected. The revascularization rate was observed at 0.5 h, 1.0 h, 1.5 h, and 2.0 h after intervention. The echocardiography was used to detect the hemodynamic related indicators in the two groups, the Perooll method was used to separate and count the CEC, and the radioimmunoassay was used to detect the level of endothelin-1 (ET-1). t test, χ² test, and Fisher exact test were used. Results　There were no statistically significant differences in the levels of mean left atrial pressure (mLAP), mean pulmonary arterial pressure (mPAP), and malignant mitral valve prolapse (mMVP) between the two groups before treatment (all P>0.05), but the levels of mLAP, mPAP, and mMVP decreased after treatment (all P<0.05), and the decrease was more significant in the study group (all P<0.05). There were no statistically significant differences in the levels of ET-1 and CEC between the two groups before treatment (both P>0.05), but the levels of ET-1 and CEC in the two groups decreased after treatment (all P<0.05), and the decrease was more significant in the study group (both P<0.05). The revascularization rate in the study group was higher than that in the control group at different time points 26.67% (12/45) vs. 6.67% (3/45), 35.56% (16/45) vs. 13.33% (6/45), 60.00% (27/45) vs. 33.33% (15/45), 77.78% (35/45) vs. 51.11% (23/45); all P<0.05]. There were no statistically significant differences in the incidences of cardiovascular events and complications between the two groups (all P>0.05). Conclusion　Intravenous thrombolysis with half-dose reteplase can improve the hemodynamics in patients with AMI, improve the vascular endothelial cell injury by inhibiting CEC expression, and has a low complication rate, which is safe for the treatment of AMI.