| 王志兴,王国良.沙库巴曲缬沙坦对经皮冠状动脉介入术后血管内皮功能、心肌损伤和近期预后的影响[J].安徽医药,2021,25(4):821-825. |
| 沙库巴曲缬沙坦对经皮冠状动脉介入术后血管内皮功能、心肌损伤和近期预后的影响 |
| Influences of sakubatrevalsartan on vascular endothelial function, myocardial injury and short-term prognosis after percutaneous coronary intervention |
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| DOI：10.3969/j.issn.1009-6469.2021.04.046 |
| 中文关键词: 心肌梗死 沙库巴曲缬沙坦 经皮冠状动脉介入治疗 内皮，血管 一氧化氮 肌酸激酶 肌钙蛋白 心肌损伤 预后 |
| 英文关键词: Myocardial infarction Sacubitril valsartan sodium tablets Percutaneous coronary intervention Endothelium, vascular Nitric oxide Creatine kinase Troponin Myocardial injury Prognosis |
| 基金项目:2018年度河南省医学科技攻关计划联合共建项目(2018020314) |
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| 中文摘要: |
| 目的探讨沙库巴曲缬沙坦对急性心肌梗死(Acute myocardial infarction，AMI)经皮冠状动脉介入术(Percutaneous coronary intervention，PCI)后血管内皮功能、心肌损伤和近期预后的影响。方法选取 2017年 6月至 2019年 3月濮阳油田总医院收治的行 PCI治疗的 AMI病人 97例，随机数字表法分为对照组(48例)与观察组(49例)。对照组给予基础用药及比伐卢定治疗，观察组在对照组基础上另给予沙库巴曲缬沙坦治疗。观察应用主动脉内球囊反搏术(Intra-aortic balloon pump，IABP)处理的病人情况，对比治疗前、治疗 1d及治疗 7d后血管内皮功能相关指标［一氧化氮(NO)、内皮素(ET)、可溶性细胞间黏附因子 -1(sICAM-1)］、心肌损伤标志物［肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白 Ⅰ(cTnⅠ)、心肌肌钙蛋白 T(cTnT)］水平变化，比较术后 3个月心脏不良事件发生情况。结果观察组有 1例采用 IABP治疗，对照组有 2例采用 IABP治疗，均恢复良好； NO、ET、sICAM-1、CK-MB、cTnⅠ、cTnT在组间、时间及交互方面比较差异有统计学意义(P<0.05)；观察组治疗 1d后 NO、ET、sICAM-1、 CK-MB、cTnⅠ、cTnT水平分别为(62.19±7.04)μmol/L、(73.48±6.49)mg/L、(190.62±16.35)ng/L、(113.38±19.45)U/L、(2.81±0.53) μg/L、(0.66±0.17)μg/L，治疗 7d后分别为(86.19±10.24)μmol/L、(42.69±5.13)mg/L、(160.75±14.36)ng/L、(62.36±13.69)U/L、(1.21±0.34)μg/L、(0.21±0.06)μg/L；对照组治疗 1d后 NO、ET、sICAM-1水平分别为(58.45±6.38)μmol/L、(78.06±7.01)mg/L、(198.34±17.59)ng/L、(122.59±20.06)U/L、(3.19±0.57)μg/L、(0.75±0.21)μg/L，治疗 7d后分别为(73.61±9.38)μmol/L、(54.87±5.39)mg/L、(176.62±14.51)ng/L、(75.74±14.58)U/L、(1.49±0.41)μg/L、(0.33±0.09)μg/L，两组治疗 1d及 7d后 NO均高于治疗前，两组治疗 7d后 NO均高于治疗 1d，观察组治疗 1d及 7d后均高于对照组，差异有统计学意义(P<0.05)；两组治疗 1d及 7d后 ET、sICAM-1、CK-MB、cTnⅠ、cTnT均低于治疗前，两组治疗 7d后 ET、sICAM-1、CK-MB、cTnⅠ、cTnT均高于治疗 1d，观察组治疗 1d及 7d后均低于对照组，差异有统计学意义(P<0.05)；观察组术后 3个月总心脏不良事件发生率为 12.24%，低于对照组的 29.17%，差异有统计学意义(P<0.05)。结论沙库巴曲缬沙坦可改善 AMI病人 PCI术后血管内皮功能，减轻心肌损伤，并可改善近期预后，可推广应用于临床治疗中。 |
| 英文摘要: |
| Objective To explore the influences of sakubatrevalsartan on vascular endothelial function, myocardial injury and short-term prognosis after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI).Methods Ninety-seven AMI patients who were treated with PCI admitted in Puyang Oilfield General Hospital from June 2017 to March 2019 were selected and assigned into control group (48 cases) and observation group (49 cases) by random number table method. The control group wastreated with basic medicine and bivalirudin, while the observation group was treated with sacubitrilvalsartan on the basis of the controlgroup. The patients treated with intra-aortic balloon pump (IABP) and the situation after treatment were observed. The related indexesof vascular endothelial function [nitric oxide (NO), endothelin (ET), soluble intercellular adhesion factor-1 (sICAM-1)] and myocardial injury markers [creatine kinase isoenzyme (CK-MB), cardiac troponin I (cTnI), cardiac troponin T (cTnT)] before treatment, after 1d and7d of treatment were compared, and the incidence of adverse cardiac events at 3 months after operation were also compared.Results One case in the observation group was treated with IABP, and two cases in the control group were treated with IABP, all recovered well.CTnT levels were significantly different in group, time and interaction (P<0.05). There were significantly different in NO, ET, sICAM-1, CK-MB, cTnⅠand cTnT among the groups, time and interactions (P<0.05). The NO, ET, sICAM-1, CK-MB, cTnⅠand cTnT levels inthe observation group after 1d of treatment were (62.19±7.04) μmol/L, (73.48±6.49) mg/L, (190.62±16.35) ng/L, (113.38±19.45) U/L,(2.81±0.53) μg/L, (0.66±0.17) μg/L, which were (86.19±10.24) μmol/L, (42.69±5.13) mg/L, (160.75±14.36) ng/L, (62.36±13.69) U/L,(1.21±0.34) μg/L, (0.21±0.06) μg/L after 7d of treatment. The NO, ET, sICAM-1, CK-MB, cTnⅠand cTnT levels in the study group after 1d of treatment were (58.45±6.38) μmol/L, (78.06±7.01) mg/L, (198.34±17.59) ng/L, (122.59±20.06) U/L, (3.19±0.57) μg/L, (0.75±0.21) μg/L, which were (73.61±9.38) μmol/L, (54.87±5.39) mg/L, (176.62±14.51) ng/L, (75.74±14.58) U/L, (1.49±0.41) μg/L, (0.33±0.09) μg/L after 7d of treatment. The NO levels in the two groups after 1d and after 7d of treatment were higher than those before treatment, and the NO levels in the two groups after 7d of treatment were higher than those after 1d of treatment, which in the observationgroup after 1d and 7d of treatment were higher than those in the control group, and there were statistically significant differences (P< 0.05). The levels of ET, sICAM-1, CK-MB, cTnⅠ and cTnT in the two groups after 1d and 7d of treatment were lower than those beforetreatment, and the levels of ET, sICAM-1, CK-MB, cTnⅠ and cTnT in the two groups after 7d of treatment were lower than those after1d of treatment, which in the observation group after 1d and 7d of treatment were lower than those in the control group, and there werestatistically significant differences significant (P < 0.05). The total incidence rate of adverse cardiac events in the observation group was12.24%, which was lower than that of 29.17% in the control group, and there was a statistically significant difference (P<0.05).Conclu? sion Sacubitrilvalsartan can improve the vascular endothelial function of AMI patients after PCI, reduce myocardial injury and improve the short-term prognosis, which can be widely used in clinical treatment. |
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