CAJ | 학술논문

目的探讨阿托伐他汀联合曲美他嗪治疗急性心肌梗死行急诊冠状动脉介入术后无血流/慢血流现象中的作用.方法 2007年4月至2012年5月因ST段抬高型心肌梗死行急诊冠状动脉介入术后发生无复流或慢血流现象的患者32例,在常规治疗基础上给予曲美他嗪片60 mg/d,阿托伐他汀钙片20 mg/d,疗程6个月.观察治疗前及治疗后6个月患者的临床症状缓解,运动负荷心电图转阴,冠状动脉造影及血清超敏C反应蛋白(hs-CRP),基质金属蛋白酶9(MMP-9),肿瘤坏死因子α(TNF-α),白细胞介素6(IL-6)的变化.结果 (1)治疗后28例患者胸痛症状明显改善,发作次数减少,有效率87.5％ (28/32).运动负荷心电图结果:转为阴性患者29例,有效率90.6％.冠状动脉造影结果:冠状动脉血流帧计数治疗前35.34±7.43,治疗后20.17±4.36,二者差异有统计学意义(t=2.409,P＜0.05).(2)治疗后与治疗前比较,治疗后血清hs-CRP(3.34±0.47) mg/L、MMP-9(173.09±42.19)μg/L、TNF-α(8.47±2.09) μg/L及IL-6(89.37±18.72) ng/L水平较治疗前[(12.34±2.43) mg/L、(972.68±131.91) μg/L、(23.54±7.48) μg/L、(154.39±42.07) ng/L]明显降低,差异有统计学意义(t值分别为2.537、2.789、2.691、2.430,P＜0.01或P＜0.05).结论急诊冠状动脉介入术后无血流/慢血流现象与炎症反应具有一定的相关性；曲美他嗪联合他汀类药物治疗能够明显改善冠状动脉术后无血流/慢血流现象,对心功能可能具有一定的改善作用.
목적 탐토아탁벌타정연합곡미타진치료급성심기경사행급진관상동맥개입술후무혈류/만혈류현상중적작용.방법 2007년4월지2012년5월인ST단태고형심기경사행급진관상동맥개입술후발생무복류혹만혈류현상적환자32례,재상규치료기출상급여곡미타진편60 mg/d,아탁벌타정개편20 mg/d,료정6개월.관찰치료전급치료후6개월환자적림상증상완해,운동부하심전도전음,관상동맥조영급혈청초민C반응단백(hs-CRP),기질금속단백매9(MMP-9),종류배사인자α(TNF-α),백세포개소6(IL-6)적변화.결과 (1)치료후28례환자흉통증상명현개선,발작차수감소,유효솔87.5％ (28/32).운동부하심전도결과:전위음성환자29례,유효솔90.6％.관상동맥조영결과:관상동맥혈류정계수치료전35.34±7.43,치료후20.17±4.36,이자차이유통계학의의(t=2.409,P＜0.05).(2)치료후여치료전비교,치료후혈청hs-CRP(3.34±0.47) mg/L、MMP-9(173.09±42.19)μg/L、TNF-α(8.47±2.09) μg/L급IL-6(89.37±18.72) ng/L수평교치료전[(12.34±2.43) mg/L、(972.68±131.91) μg/L、(23.54±7.48) μg/L、(154.39±42.07) ng/L]명현강저,차이유통계학의의(t치분별위2.537、2.789、2.691、2.430,P＜0.01혹P＜0.05).결론 급진관상동맥개입술후무혈류/만혈류현상여염증반응구유일정적상관성；곡미타진연합타정류약물치료능구명현개선관상동맥술후무혈류/만혈류현상,대심공능가능구유일정적개선작용.
Objective To investigate the therapeutic effect of trimetazidine(TMZ) and atorvastatin on coronary no-flow/slow-flow phenomenon (CNFP/CSFP) emergency pereutaneous coronary intervention (PCI)Methods Thirty-two patients with acute myocardial infarction were selected as our subjects,who hospitalized from April 2007 to May 2012 after PCI with CNFP/CSFP.Patients were administrated with the TMZ (60 mg/d)and atorvastatin (20 mg/d) for 6 months besides the routine therapy.The changes of the clinical symptoms including ECG exercise test,coronary flow of coronary angiography(CAG) were recorded and the level of serum high sensitivity C-reactive protein (hs-CRP),matrix metalloproteinase-9 (MMP-9),tumor necrosis factor-α (TNF-α) and interleukin-6(IL-6) were measured before and after the treatment.Results (1)The symptoms of the patients were improved remarkably;the effective rate was 87.5％ (28/32).The improving rate of ECG was 90.6％.The CTFC of patients after treatment was (20.17 ± 4.36),significantly lower than that of before treatment (35.34 ± 7.43,t =2.409,P ＜ 0.05).(2) The levels of hs-CRP,MMP-9,TNF-a and IL-6 at after treatment were (3.34 ±0.47) mg/L,(173.09 ±42.19) μg/L,(8.47 ±2.09) μg/L,(89.37 ± 18.72) ng/L,lower than that of before treatment ((12.34 ± 2.43) mg/L,(972.68 ± 131.91) μg/L,(23.54 ± 7.48) μg/L,(154.39 ± 42.07) ng/L),and difference were significant (t =2.537,2.789,2.691,2.430,P ＜ 0.01 or P ＜0.05).Conclusion The therapy approach of TMZ and atorvastatin plus routine treatment of nitrate and aspirin showed a better therapeutic effect on CNFP/CSFP.The causes of CNFP/CSFP may relate to inflammation.