远端缺血预处理对肥胖急性心肌梗死患者急诊PCI术后脂肪素水平的影响

摘要

Objective To observe the effect of remote ischemic adaptation ( RIPC) on the level of serum visfatin (Apelin) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI).Methods For-ty eight obesity AMI patients from June 2013 to June 2014 were enrolled in the 309 th Hospital of Chinese People Liberation Army and they were divided into two groups equally and randomly: RIPC group and non RIPC group .All the AMI patients were received PCI treatment .The levels of apelin , NT-proBNP and cTnI were measured before PCI and one week after PCI . All the patients were following a 2 years investigation for MACE rate.Results The contents of apelin[(61.4 ±11.2)ng/ml vs.(33.7 ±6.5)ng/ml, t =2.760, P =0.005] and cTnI[(77.1 ±8.6)ng/ml vs.(4.2 ±1.1) ng/ml, t =2.632, P =0.006] in RICP group were significantly decreased one week after PCI treatment .However, the levels of apelin [(62.7 ± 9.6) ng/ml vs.(79.3 ±14.1)ng/ml, t =2.127, P =0.021] and NT-proBNP [(357.6 ±31.5) pg/ml vs.(412.3 ± 72.8) pg/ml, t =1.992, P =0.027] were increased after PCI in non RIPC group .Correlation analysis showed that RIPC was negatively related with △apelin ( r =-0.698, P <0.05) and MACE ( r =-0.611, P <0.05).MACE was negative-ly associated with △apelin ( r =-0.653, P <0.05).Conclusion RIPC can improve long term outcome in obesity patients with AMI by regulating serum levels of apelin .%目的：观察远端缺血预处理（RIPC）对肥胖急性心肌梗死（AMI）患者急诊介入治疗（PCI）术后脂肪素（ apelin）水平的影响。方法选取2013年6月—2014年6月解放军第309医院心血管病中心诊断为AMI并成功行急诊PCI治疗的48例肥胖患者作为研究对象，随机数字表法分为对照组（ n ＝24）和RIPC组（ n ＝24）。对照组予AMI常规治疗后行PCI术，RIPC组在常规治疗基础上，于PCI术前进行1次RIPC，于PCI术后每天3次RIPC，连续3天。检测PCI术前和术后1周apelin、N末端脑钠肽前体（NT－proBNP）和肌钙蛋白I（cTnI）水平。随访2年，统计主要不良事件（ MACE）发生情况及各指标间的相关性。结果与术前比较，PCI术后1周RIPC组患者血清apelin和 cTnI水平明显下降[（61．4±11．2） ng／ml vs．（33．7±6．5）ng ／ml， t ＝2．760， P ＝0．005；（77．1±8．6） ng／ml vs．（4．2±1．1） ng／ml， t ＝2．632， P ＝0．006]；而对照组可见血清cTnI水平明显下降[（73．6±7．2） ng／ml vs．（15．2±3．5） ng／ml， t ＝2．902， P ＝0．003]，而apelin和和NT－proBNP水平明显上升[（62．7±9．6） ng／ml vs．（79．3±14．1） ng／ml， t ＝2．127， P ＝0．021；（357．6±31．5） pg／ml vs．（412．3±72．8） pg／ml， t ＝1．992， P ＝0．027）]。 PCI术后1周RIPC组患者血清apelin和NT－proBNP水平均明显低于对照组患者（ t ＝2．447，2．383， P ＜0．05）。 RIPC与△apelin、MACE呈负相关（ r ＝－0．698， P ＜0．05；r ＝－0．611， P ＜0．05），△apelin与MACE呈负相关（ r ＝－0．653， P ＜0．05）。结论 RIPC干预治疗可能通过调节脂肪因子apelin浓度改善肥胖AMI患者PCI术后远期预后情况。