替罗非班辅助 PCI 对急性 ST 段抬高型心肌梗死患者血清sST2 及 P T X‐3 水平的影响

摘要

目的 探讨替罗非班辅助PCI对急性ST段抬高型心肌梗死(STEMI)患者的临床疗效及对血清可溶性基质裂解素2 (sST2)及正五聚体蛋白‐3 (PTX‐3)水平的影响.方法 2014年～2017年在我院就诊的146例STEMI患者,患者被随机均分为单纯PCI组及联合治疗组(替罗非班+ PCI术) ,术后两组均接受阿司匹林联合氯吡格雷治疗7d .随访6个月,观察比较两组术前、术后1个月TIMI血流分级、血清sST2和PTX‐3水平,术前、术后6个月LVEDd , LVEF ,以及随访6个月内的主要不良心血管事件(MACE)率.结果 治疗后,联合治疗组TIMI＜3级比例显著低于单纯 PCI组(13. 7% 比34. 2%, P＝ 0.003) .与单纯 PCI组比较,联合治疗组术后6个月LVEF [ (54.34 ± 6.57)% 比(61.42 ± 7.31)%]显著升高,而LVEDd [ (49.35 ± 3. 13) mm比(43.54 ± 3.44) mm] 、术后1个月血清sST2 [ (57. 42 ± 8.93) μg／L比(35. 22 ± 8. 53) μg／L]及PTX‐3 [ (0.64 ± 0. 11) μg／L比(0. 43 ± 0. 09) μg／L]水平均显著降低( P均＝0. 001) ;联合治疗组MACE总发生率显著降低(24.7% 比2. 7%, P＝0. 001) .结论 替罗非班辅助 PCI 有利于改善 STEMI 术后心功能、降低血清 sST2 及 PTX‐3 水平,减少MACE发生率,值得推广.%To explore therapeutic effect of tirofiban‐assisted percutaneous coronary intervention (PCI) on patients with acute ST‐segment elevation myocardial infarction (STEMI) and its influence on serum levels of soluble stromelysin 2 (sST2) and pentraxin (PTX)‐3. Methods : A total of 146 STEMI patients treated in our hospital from 2014 to 2017 were randomly and equally divided into pure PCI group and combined treatment group (received tirofi‐ ban and PCI ) , both groups received aspirin and clopidogrel for 7d after PCI .After treatment , TIMI blood flow grade , serum levels of sST2 and PTX‐3 , LVEDd and LVEF and incidence of major adverse cardiovascular events (MACE) were observed and compared between two groups .Results : After treatment , percentage of TIMI＜grade 3 in combined treatment group was significantly lower than that of pure PCI group (13. 7% vs.34. 2%, P＝0.003 ?).Compared with pure PCI group , there was significant rise in LVEF [ (54.34 ± 6.57 )% vs.(61.42 ± 7.31)%] and significant reductions in LVEDd [ (49. 35 ± 3.13) mm vs.(43.54 ± 3. 44) mm] after six months , ser‐um levels of sST2 [ (57.42 ± 8.93) μg／L vs .(35. 22 ± 8. 53) μg／L] and PTX‐3 [ (0.64 ± 0.11) μg／L vs.(0. 43 ± 0.09) μg／L] after one month in combined treatment group , P＝0. 001 all.During six‐month follow‐up , total inci‐dence rate of MACE in combined treatment group was significantly lower than that of pure PCI group (2. 7% vs. 24.7%, P＝0. 001).Conclusion : Tirofiban‐assisted PCI is beneficial for improving cardiac function , reducing ser‐um sST2 and PTX‐3 levels and incidence rate of MACE in STEMI patients after PCI , which is worth extending .24