CAJ | 학술논문

目的：观察中高危非ST段抬高急性冠脉综合征（NSTACS）患者经皮冠状动脉介入治疗（PCI）术前应用替罗非班的影响。方法入选2009年5月至2010年7月在北京安贞医院心内科住院拟行PCI的中高危NSTACS患者（不稳定型心绞痛或急性非ST段抬高型心肌梗死）80例，年龄18~75岁。术前组（38例）：患者在造影前（12±2）h开始首先给予10μg/kg负荷量的替罗非班，3 min内推注完毕，然后以0.15μg/kg/min静滴至PCI完成后24 h；术中组（42例）：在指引导管到位后给予10μg/kg的负荷剂量，3 min内推注完毕，然后改为0.15μg/kg/min静滴至PCI完成后24 h。比较两组院内、30 d内主要不良心血管事件发生情况。术前和术后检测高敏C反应蛋白（hs-CRP）和可溶性CD40配体（sCD40L）、肌钙蛋白I（TNI）和肌酸激酶同工酶（CK-MB）。结果与本组术前比较，术前组在PCI术后CK-MB、hs-CRP和sCDL40降低，为（22.91±11.76）U/L vs.（14.69±15.72）U/L、（16.50±7.76）mg/L vs.（10.91±13.16）mg/L、（18.92±8.90）μg/L vs.（12.65±10.99）μg/L，差异有统计学意义（P均＜0.05）。与术中组比较，术前组在PCI术后sCDL40降低[（14.23±8.91）μg/L vs.（12.65±10.99）μg/L]，差异有统计学意义（P＜0.05）。两组终点事件发生率比较，无统计学意义（P=0.860）。结论早期PCI术前应用替罗非班能抑制炎症反应，明显减少心肌的急性损害。
목적：관찰중고위비ST단태고급성관맥종합정（NSTACS）환자경피관상동맥개입치료（PCI）술전응용체라비반적영향。방법입선2009년5월지2010년7월재북경안정의원심내과주원의행PCI적중고위NSTACS환자（불은정형심교통혹급성비ST단태고형심기경사）80례，년령18~75세。술전조（38례）：환자재조영전（12±2）h개시수선급여10μg/kg부하량적체라비반，3 min내추주완필，연후이0.15μg/kg/min정적지PCI완성후24 h；술중조（42례）：재지인도관도위후급여10μg/kg적부하제량，3 min내추주완필，연후개위0.15μg/kg/min정적지PCI완성후24 h。비교량조원내、30 d내주요불양심혈관사건발생정황。술전화술후검측고민C반응단백（hs-CRP）화가용성CD40배체（sCD40L）、기개단백I（TNI）화기산격매동공매（CK-MB）。결과여본조술전비교，술전조재PCI술후CK-MB、hs-CRP화sCDL40강저，위（22.91±11.76）U/L vs.（14.69±15.72）U/L、（16.50±7.76）mg/L vs.（10.91±13.16）mg/L、（18.92±8.90）μg/L vs.（12.65±10.99）μg/L，차이유통계학의의（P균＜0.05）。여술중조비교，술전조재PCI술후sCDL40강저[（14.23±8.91）μg/L vs.（12.65±10.99）μg/L]，차이유통계학의의（P＜0.05）。량조종점사건발생솔비교，무통계학의의（P=0.860）。결론조기PCI술전응용체라비반능억제염증반응，명현감소심기적급성손해。
Objective To observe the influence of preoperative tirofiban administration on the inflammatory reactions in patients with middle-high risk of non-ST-segment elevation acute coronary system (NSTEACS). Methods The patients (n=80 and aged from 18 to 75) planed to have percutaneous coronary intervention (PCI) were chosen from May 2009 to Jul. 2010, and divided into 2 groups. The pre-PCI group (n=38) was given tirofiban in loading dose (10 g/kg injected within 3 min) at first and (12±2) h before coronary angiography and then given intravenous drip of tirofiban (0.15 g/kg/min) for 24 h after PCI. The control group (n=42) was given tirofiban in loading dose (10 g/kg injected within 3 min) after guiding catheter placed and then given intravenous drip of tirofiban (0.15 g/kg/min) for 24 h after PCI. The incidence of major adverse cardiovascular events (MACE) was compared between 2 group during hospital stay and 30 d after discharge. The levels of high-sensitivity C-reactive protein (hs-CRP), soluble CD40 ligand (sCD40L), cardiac troponin I (cTnI) and creatine kinase MB (CK-MB) were detected befor and after PCI. Results In pre-PCI group, the levels of CK-MB, hs-CRP and sCDL40 decreased after PCI [(22.91±11.76) U/L vs. (14.69±15.72) U/L], [(16.50±7.76) mg/L vs. (10.91±13.16) mg/L], [(18.92± 8.90) g/L vs. (12.65±10.99) g/L, all P<0.05]. Compared with control group, sCDL40 decreased in pre-PCI group after PCI [(14.23±8.91) g/L vs. (12.65±10.99) g/L, P<0.05]. The difference in incidence of endpoint events had no statistical significance (P=0.860) between 2 groups. Conclusion The early administration of tirofiban before PCI can inhibit the inflammatory reactions and relieve acute myocardial impairment.