血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂在老年冠脉介入再灌注损伤中的疗效

Effects of Glycoprotein Ⅱb/Ⅲa Inhibition on Myocardial Reperfusion Injury during Coronary Intervention in Elderly Patients

关键词:  冠脉介入  再灌注损伤  血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂

Key words:  percutaneous coronary intervention  reperfusion injury  GPⅡb/Ⅲa receptor inhibitor

摘要:

摘要：目的 研究血小板糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂在老年冠脉介入(PCI)再灌注损伤(MIRI)中的疗效。方法 141例老年急性冠脉综合征(ACS)行PCI患者，随机分成试验组和对照组，试验组术前给予常规药物+GPⅡb/Ⅲa受体拮抗剂，对照组术前给予常规药物+安慰剂，观察支架植入后即刻冠脉造影及术后1周心电图、动态心电图和超声心动图结果。结果 对照组共9例(13.0%)有MIRI，试验组共2例(2.8%)有MIRI，2组比较TIMI血流有统计学差异(P<0.05)，对照组心肌梗死再发、恶性心律失常、心源性休克的发生率较高。结论 GPⅡb/Ⅲa受体拮抗剂能明显改善老年PCI患者的MIRI，也提示血小板激活是这类患者的重要形成因素。

Abstract:

OBJECTIVE To evaluate the effect of platelet glycoprotein(GP) Ⅱb/Ⅲa receptor inhibitor on myocardial ischemical reperfusion injury (MIRI) during percutaneous coronary intervention(PCI) in elderly patients. METHODS We randomly assigned 141 elderly patients with acute coronary syndrome (ACS) either to routine drugs plus tirofiban (72 patients) or routine drugs plus placebo (69 patients) before they underwent PCI. Coronary angiography immediately afterward PCI and electrocardiogram (ECG) and ambulatory electrocardiography (AECG) and doppler echocardiography one week afterward PCI were evaluated. RESULTS In 141 patients undergoing PCI, MIRI was described by operators in 9(13.0%) patients and 2(2.8%) patients respectively. TIMI flow was significantly different in two groups (P<0.05). The incidence of myocardial infarction and arrhythmias and cardiogenic shock of the patients in control group was significantly higher. CONCLUSION As compared with placebo, GPⅡb/Ⅲa receptor inhibitor improves MIRI during PCI in elderly patients. This suggests GPⅡb/Ⅲa receptor inhibitor is an effective adjunctive therapy for MIRI, and that platelet mediated microvascular thrombus and embolization may be the mechanism of MIRI during PCI in elderly patients.