丹参多酚酸盐减少PCI相关性心肌梗死的初步研究

A Preliminary Study on the Reduction of PCI Associated Myocardial Infarction by Salvianolate

关键词:  丹参多酚酸盐  心绞痛  PCI相关性心肌梗死

Key words:  salvianolate  angina pectoris  PCI-related myocardial infarction

摘要:

目的 观察丹参多酚酸盐减少经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）相关性心肌梗死的作用并研究其机制。方法 将心绞痛患者分为对照组和丹参多酚酸盐组，2组均给予心绞痛标准治疗。丹参多酚酸盐组在PCI术前和围术期静脉滴注丹参多酚酸盐。检测患者入院后第1天以及PCI术后24 h的肌钙蛋白I（cardiac troponin I，cTnI），可溶性血栓调节蛋白（soluble thrombomodulin，sTM）、血管性血友病因子（von willebrand factor，vWF）的变化情况。观察2组患者的基线资料，以及PCI术后6个月的心血管事件和处理措施。结果 2组患者PCI术后均出现sTM、vWF、cTnI水平升高。丹参多酚酸盐组PCI术后的sTM、vWF显著低于对照组，差异有统计学意义（P<0.05）。丹参多酚酸盐组PCI相关性心肌梗死发生率低于对照组，差异有统计学意义（P<0.05）。丹参多酚酸盐组术后6个月心绞痛症状再发率低于对照组（P<0.05）。2组再次冠脉造影的差异无统计学意义，2组均未出现靶血管血运重建、非致死性心肌梗死、支架内血栓形成、心源性休克、猝死等不良心血管事件。结论 丹参多酚酸盐可能通过减少PCI术中血管内皮损伤，从而减少PCI相关性心肌梗死，改善患者预后。

Abstract:

OBJECTIVE To observe the effect and mechanism of salvianolate on percutaneous coronary intervention (PCI) related myocardial infarction. METHODS The patients with angina pectoris were divided into control group and salvianolate group. Both groups were given standard angina pectoris treatment. The patients in salvianolate group received infusion of salvianolate before PCI and perioperative. Cardiac troponin I (cTnI), soluble thrombomodulin (sTM), von willebrand factor (vWF) were measured on the first day after admission and 24 h after PCI. The baseline data of the two groups patients as well as the clinical events 6 months after PCI and the treatment of cardiovascular events were observed. RESULTS The levels of sTM, vWF and cTnI in both group increased after PCI. The level of sTM and vWF in the salvianolate group after PCI was less than control group, the difference was statistically significant (P<0.05). The incidence of PCI-related myocardial infarction in salvianolate group was lower than that in control group, the difference was statistically significant (P<0.05). The recurrence rate of angina pectoris in salvianolate group was lower than that in control group 6 months after operation (P<0.05). There was no significant difference in coronary angiography between the two groups. There were no adverse cardiovascular events such as target vessel revascularization, non-fatal myocardial infarction, stent thrombosis, cardiogenic shock, or sudden cardiovascular death in both two groups. CONCLUSION Salvianolate may reduce PCI-induced myocardial infarction and improve prognosis of patients by decreasing vascular endothelial injury during PCI.