重组人脑利钠肽联合厄贝沙坦对心肌梗死PCI术后患者疗效及HCY、IMA、Lp-PLA2影响

Effect of Recombinant Human Brain Natriuretic Peptide Combined with Irbesartan on Patients with Myocardial Infarction After PCI and the Effects on HCY, IMA and Lp-PLA2

关键词:  重组人脑利钠肽  厄贝沙坦  急性心肌梗死  经皮冠状动脉介入术

Key words:  recombinant human brain natriuretic peptide  irbesartan  acute myocardial infarction  percutaneous coronary intervention

摘要:

目的 观察重组人脑利钠肽（recombinant human brain natriuretic peptide，rhBNP）联合厄贝沙坦对急性心肌梗死（acutemyocardial infarction，AMI）经皮冠状动脉介入术（percutaneous coronary intervention，PCI）后患者疗效及对同型半胱氨酸（homocysteine，Hcy）、缺血修饰白蛋白（ischemia modified albumin，IMA）、脂蛋白相关磷脂酶A （2 lipoprotein-associated phospholipase A2，Lp-PLA2）影响。方法 选取2015年1月—2017年12月150例行PCI术成功的AMI患者，随机分为观察组（75例）和对照组（75例），对照组患者术后予常规药物治疗和静脉注射rhBNP72 h；观察组在此基础上给予口服厄贝沙坦150 mg·d^-1。观察2组患者临床疗效、心肌酶学改变、心功能指标及不良反应情况；观察2组患者Hcy、IMA、Lp-PLA2改变。结果 观察组治疗后的临床治疗总有效率（89.33%）显著高于对照组（65.33%）（P<0.05）。与治疗前相比，治疗后2组患者体内CK和CK-MB峰值明显降低，观察组患者明显低于对照组（P<0.05）。与对照组比较，治疗后，观察组左心室功能参数改善明显（P<0.05）；血清HCY、IMA、Lp-PLA2含量下降更为明显（P<0.05）；心源性死亡、心肌二次梗死、再发心绞痛、心力衰竭人数较少，但不具有统计学差异；不良反应总数明显较低（P<0.05）。结论 rhBNP联合厄贝沙坦对PCI术后的AMI患者心肌具有保护作用，明显改善患者预后，可明显降低患者体内HCY、IMA、Lp-PLA2水平。

Abstract:

OBJECTIVE To observe the effect of recombinant human brain natriuretic peptide(rhBNP) combined with irbesartan on acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI) and its effect on homocysteine(Hcy), ischemia modified albumin(IMA) and 2 lipoprotein-associated phospholipase A2(Lp-PLA2). METHODS The 150 patients with AMI and PCI who were admitted from January 2015 to December 2017 were randomly divided into observation group (75 cases) and control group (75 cases). The control group received conventional drug treatment and intravenous injection of rhBNP for 72 h; the observation group was given oral irbesartan 150 mg·d^-1 based on observation group. The clinical efficacy of the two groups was observed. The changes of myocardial enzymology, cardiac function, vascular endothelial function and adverse reactions were observed. The changes of HCY, IMA and Lp-PLA2 were observed in the two groups. RESULTS The effective rate of clinical treatment(89.33%) in the observation group was significantly higher than that in the control group(65.33%)(P<0.05). Compared with before treatment, the peaks of CK and CK-MB in the two groups were significantly lower, and they were lower in observation group than in the control group(P<0.05). After treatment, compared with control group, in the observation group, the improvement of left ventricular function parameters was significantly higher(P<0.05); the serum levels of HCY, IMA and Lp-PLA2 were significantly lower(P<0.05); the number of patients with cardiac death, myocardial infarction, recurrent angina, and heart failure was lower, but there was no statistical difference; the total number of adverse reactions was significantly lower(P<0.05). CONCLUSION rhBNP combined with irbesartan can protect the myocardium of patients with AMI after PCI, significantly improve the prognosis of patients, and significantly reduce the levels of HCY, IMA and Lp-PLA2 in patients.