注射用心肌肽对PCI治疗的ST段抬高型心肌梗死患者心功能的影响

邹宇婷; 姜潇思; 孙志军; 毛琳霜; 陈韵岱; 钱赓

doi:10.3969/j.issn.2095-5227.2021.09.001

注射用心肌肽对PCI治疗的ST段抬高型心肌梗死患者心功能的影响

Effect of cardiomyopeptidin on cardiac function in patients with ST-segment elevation myocardial infarction after primary percutaneous coronary intervention

摘要

摘要:
背景目前，治疗ST段抬高型心肌梗死(ST-segment elevation myocardial infarction，STEMI)的首选方法是直接经皮冠状动脉介入(percutaneous coronary intervention，PCI)治疗。既往研究发现注射用心肌肽能够改善心肌缺血再灌注损伤，对接受PCI的STEMI患者临床疗效有潜在益处。
目的探讨注射用心肌肽在接受PCI治疗的STEMI患者中的心肌保护作用。
方法连续募集2014年7月-2017年6月在解放军总医院一中心心血管内科接受PCI治疗的STEMI患者310例。将患者随机分为心肌肽组(n=154)和对照组(n=156)。入组的患者在PCI期间至术后3 d分别静脉输注3 mg/(kg·d)的注射用心肌肽或安慰剂(0.9%氯化钠注射液)治疗。术后7～30 d使用多普勒超声心动图评估左心室射血分数(left ventricular ejection fraction，LVEF)的变化，术后1个月后行6分钟步行试验量化患者的运动能力，观察PCI前后患者B型脑利钠肽(brain natriuretic peptide，BNP)的变化。
结果与对照组比较，心肌肽组出院后复查的LVEF显著增加(57.8% ± 12.8% vs 51.0% ± 12.1%，P＜0.001)，术后BNP水平显著降低Md(IQR): 848(732，940) pg/mL vs 1 150(1 038，1 245) pg/mL，P＜0.001；此外，心梗恢复期心肌肽组6分钟步行试验的距离增加(773.7 ± 166.2) m vs (618.2 ± 186.3) m，P＜0.001。
结论注射用心肌肽可以改善PCI治疗的STEMI患者的心功能和运动耐量，可辅助STEMI患者的PCI治疗。

Abstract:
Background Currently, the first choice for treatment of patients with ST-segment elevation myocardial infarction (STEMI) is percutaneous coronary intervention (PCI), and previous studies have found that cardiomyopeptidin can improve myocardial ischemia-reperfusion injury and have potential benefits for the clinical outcome of STEMI patients undergoing PCI.
Objective To investigate the myocardium protection effect of cardiomyopeptidin in patients with STEMI receiving PCI therapy.
Methods Consecutive patients who received PCI treatment in the department of cardiology, the First Medical Center, Chinese PLA General Hospital from July 2014 to June 2017 were recruited in the study. These patients were randomized to cardiomyopeptidin group (n=154) and control group (n=156). The enrolled patients received intravenous infusion 3 mg/(kg·d) of cardiomyopeptidin orplacebo (0.9% sodium chloride injection) during the PCI until 3 days after operation, respectively. The left ventricular ejection fraction (LVEF) was evaluated with Doppler echocardiography at 7 - 30 days after PCI. The 6-minute walk test was used to evaluate the patients’ exercise capacity at one month after PCI. And we also observed the change of B-type natriuretic peptide (BNP) before and after PCI.
Results Compared with control group, the LVEF increased significantly in cardiomyopeptidin group when patients were discharged from hospital (57.8% ± 12.8% vs 51.0% ± 12.1%, P＜0.001). There was a significant decrease of BNP level after operation in the cardiomyopeptidin group (MdIQR: 848 732, 940 pg/mL vs 1 1501 038, 1 245 pg/mL, P＜0.001). In addition, the distance of 6-minute walking test increased markedly in the cardiomyopeptidin group (773.7 ± 166.2 m vs 618.2 ± 186.3 m, P＜0.001).
Conclusion Cardiomyopeptidin can improve LVEF and exercise tolerance in STEMI patients treated with PCI, making it a potential adjuvant therapy for STEMI patients treated with PCI.

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