前列地尔改善冠心病患者心肌微循环及血液流变学的疗效分析

摘要

目的:评价前列地尔对改善冠心病(CHD)患者心肌微循环功能障碍及血液流变学紊乱的临床疗效.方法:选择164例于我院就诊的CHD患者,根据随机数字表法随机均分为常规治疗组和前列地尔组(在常规治疗组基础上接受前列地尔注射液治疗),治疗疗程均为2周.检测并比较两组治疗后血清一氧化氮(NO)、血管内皮生长因子(VEGF)、血栓素β2(TXβ2)水平,以及血液流变学指标水平;比较两组治疗后冠脉造影(CAG)中的TIMI分级及心肌灌注分级(TMPG).结果:与常规治疗组相比,前列地尔组治疗后血清NO[(64.9±10.3) mmol/L比(98.8±13.2) mmol/L]、VEGF水平[(1.62±0.53) mg/L比(3.31±0.68) mg/L]显著升高,TXβ2水平[(180.4±22.8) pg/ml比(78.9±9.6) pg/ml]显著降低(P<0.05或<0.01);全血高切黏度[(5.84±0.72) mPa·s比(4.25±0.31) mPa·s]、全血低切黏度[(8.42±0.93) mPa·s比(5.31±0.68) mPa·s]、血浆黏度[(2.73±0.34) mPa·s比(1.61±0.29) mPa·s]、纤维蛋白原[(4.09±0.55) g/L比(3.13±0.55) g/L]、红细胞聚集指数[(3.85±0.47)比(2.24±0.31)]和最大血小板聚集率[(67.4±5.3)%比(48.0±3.6)%]显著降低(P均<0.05).再次接受CAG的患者中,与常规治疗组比较,前列地尔组TIMI和TMPG分级II级和III级比例显著降低,0级和I级比例显著升高,P<0.05或<0.01.结论:前列地尔能显著改善冠心病患者的心肌微循环障碍及血液流变学紊乱程度,值得推广.%Objective: To assess therapeutic effect of alprostadil on improving myocardial microcirculatory disturbance and hemorheological disorder in patients with coronary heart disease (CHD).Methods: A total of 164 CHD patients treated in our hospital were selected.According to random number table method, they were randomly and equally divided into routine treatment group and alprostadil group (received alprostadil injection based on routine treatment group), both groups were treated for two weeks.Serum levels of nitric oxide (NO), vascular endothelial growth factor (VEGF), thromboxan β2 (TXβ2) and hemorheological indexes were measured and compared between two groups after treatment;TIMI grade and TIMI myocardial perfusion grading (TMPG) of CAG were compared between two groups after treatment.Results: Compared with routine treatment group after treatment, there were significant rise in serum levels of NO[(64.9±10.3) mmol/L vs.(98.8±13.2) mmol/L]and VEGF[(1.62±0.53) mg/L vs.(3.31±0.68) mg/L], and significant reduction in serum TXβ2 level[(180.4±22.8) pg/ml vs.(78.9±9.6) pg/ml], P<0.05 or<0.01;significant reductions in whole blood high shear viscosity[(5.84±0.72) mPa·s vs.(4.25±0.31) mPa·s], whole blood low shear viscosity[(8.42±0.93) mPa s vs.(5.31±0.68) mPa s], plasma viscosity[(2.73±0.34) mPa s vs.(1.61±0.29) mPa s], fibrinogen level[(4.09±0.55) g/L vs.(3.13±0.55) g/L], erythrocyte aggregation index[(3.85±0.47) vs.(2.24±0.31)]and maximum platelet aggregation rate[(67.4±5.3)% vs.(48.0±3.6)%]in alprostadil group, P<0.05 all.Among those patients undergoing second CAG, compared with routine treatment group, there were significant reductions in percentages of TIMI and TMPG grade II and grade III, and significant rise in percentages of TIMI and TMPG grade 0 and grade I in alprostadil group, P<0.05 or <0.01.Conclusion: Alprostadil can significantly improve myocardial microcirculatory disturbance and hemorheological disorder in patients with coronary heart disease, which is worth extending.