低剂量促红细胞生成素用于急性心肌梗死患者经皮冠状动脉介入治疗术后的疗效和安全性

摘要

目的：探讨低剂量促红细胞生成素（EPO）应用于急性心肌梗死患者行经皮冠状动脉介入治疗（PCI）术后的疗效和安全性。　　方法：80例急性ST段抬高型心肌梗死且成功行PCI的患者被随机分为EPO组（n=40例）和对照组（n=40例）。EPO组在PCI术后即刻、术后第2天、术后第4天各给予EPO 6000 IU（加入100 ml 0.9％氯化钠中静脉滴注）；对照组同时给予100 ml 0.9％氯化钠静脉滴注。6个月后随访各项指标，随访项目包括血常规、左心室射血分数、左心室舒张末期容积指数、左心室收缩末期容积指数、梗死面积（单光子发射计算机断层成像术测定）、B型利钠肽（BNP）、血红蛋白（Hb）水平。记录随访期间的主要不良心血管事件及EPO相关不良反应发生情况。　　结果：两组患者一般资料差异无统计学意义。治疗6个月后，EPO组左心室射血分数较PCI术后第4天（基础值）明显改善（P<0.05），梗死面积显著减小（P<0.05），差异有统计学意义；而对照组患者治疗6个月后的左心室射血分数和梗死面积较基础值差异无统计学意义（P>0.05）。EPO组患者的左心室收缩末期容积指数由（49.76±32.65）ml/m2降至（34.78±19.98）ml/m2（P>0.05），差异无统计学意义，EPO组患者的左心室舒张末期容积指数由（92.23±27.65）ml/m2降低至（84.52±25.76）ml/m2（P>0.05），差异无统计学意义；而对照组患者的左心室舒张末期容积指数由（91.78±41.67） ml/m2上升至（93.71±31.25）ml/m2（P>0.05），差异无统计学意义。EPO组及对照组患者主要不良心血管事件及EPO相关的不良反应发生情况差异无统计学意义（P>0.05）。　　结论：低剂量EPO应用于急性心肌梗死患者具有心脏保护作用，安全性良好。%Objective: To investigate the efifcacy and safety of low dose erythropoietin (EPO) for treating the patients with acute myocardial infarction (AMI) after percutaneous coronary intervention procedure. Methods: A total of 80 patients of acute STEMI with successful PCI were randomized into 2 groups. EPO group, the patients received intravenous EPO 6000 IU in 100 ml of normal saline at immediately and 2, 4 days after PCI. Control group, the patients received 100 ml of normal saline at the same time points. n=40 in each group. The patients were followed-up for 6 months for routine blood test, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume index (LVEDVI), left ventricular end-systolic volume index (LVESVI), the size of infarction, and plasma levels of BNP, hemoglobin. The major adverse cardiovascular events (MACE) and EPO related side effects were compared between 2 groups. Results: The baseline condition was similar between 2 groups. With 6 months of treatment, EPO group showed obviously improved LVEF at 4 days after PCI, and decreased size of infarction, all P<0.05, while those indexes were similar in Control group, all P>0.05. In EPO group, with 6 months of treatment, LVESVI decreased from (49.76±32.65 ) ml/m2 to (34.78±19.98) ml/m2, LVEDVI decreased from (92.23±27.65) ml/m2 to (84.52±25.76) ml/m2, all P>0.05, and in Control group, LVEDVI increased from (91.78±41.67) ml/m2 to (93.71±31.25) ml/m2, P>0.05. The incidence of MACE and EPO related side effects were similar between 2 groups, P>0.05. Conclusion: Low dose EPO administration was effective and safe for treating AMI patients after PCI procedure.