血栓通注射液联合重组人脑利钠肽用于急性ST段抬高型心肌梗死患者急诊PCI术后的疗效观察

Observation on clinical effects of Xueshuantong Injection combined with recombinant human brain natriuretic peptide in patients with acute ST-segment elevation myocardial infarction after emergency PCI

关键词:  血栓通注射液  重组人脑利钠肽  急性ST段抬高型心肌梗死  血流动力学  心肌损伤标志物

Key words:  Xueshuantong Injection  recombinant human brain natriuretic peptide  acute ST-segment elevation myocardial infarction  hemodynamics  myocardial injury markers

摘要:

[目的] 探讨血栓通注射液联合重组人脑利钠肽（rhBNP）用于急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）术后的临床疗效。[方法] 选择2019年1月—2021年5月收治的110例行急诊PCI治疗的STEMI患者作为研究对象，采用随机数字表法分成观察组与对照组各55例。急诊PCI术后，在常规治疗的基础上观察组给予血栓通注射液联合rhBNP治疗，对照组单用rhBNP治疗。治疗前后测定两组心脏超声指标[左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、左室射血分数（LVEF）]、血流动力学参数[心输出量（CO）、左室每搏做功（LSW）、平均动脉压（MAP）]及血清N末端B型利钠肽原（NT-proBNP）、生长分化因子15（GDF-15）、可溶性致癌抑制因子2（sST2）和半乳糖凝集素3（Gal-3）水平。统计PCI术后6个月内主要心脏不良事件（MACE）发生情况。并比较两组不良反应情况。[结果] 两组治疗后LVEDV、LVESV均较治疗前显著缩小（P<0.05），LVEF较治疗前均显著增加（P<0.05）；且观察组LVEDV、LVESV及LVEF均显著优于对照组（P<0.05）。两组治疗后CO、LSW、MAP均较治疗前显著升高（P<0.05）；且观察组CO、LSW及MAP均显著高于对照组（P<0.05）。两组治疗后血清GDF-15、sST2、Gal-3和NT-proBNP浓度均较治疗前显著下降（P<0.05）；且观察组血清GDF-15、sST2、Gal-3和NT-proBNP水平显著低于对照组（P<0.05）。PCI术后随访6个月内，观察组MACE发生率为5.45%（3/55），与对照组[18.18%（10/55）]相比显著降低（P<0.05）。观察组不良反应率为12.73%（7/55），与对照组[9.09%（5/55）]比较差异无统计学意义（P>0.05）。[结论] 血栓通注射液联合rhBNP治疗能有效下调STEMI急诊PCI术后患者血清NT-proBNP、GDF-15、sST2和Gal-3的表达水平，改善PCI术后血流动力学及心功能，减少术后MACE的发生，且安全性较好。

Abstract:

[Objective] To explore the clinical efficacy of Xueshuantong Injection combined with recombinant human brain natriuretic peptide(rhBNP) in patients with acute ST-segment elevation myocardial infarction(STEMI) after emergency percutaneous coronary intervention (PCI).[Methods] The 110 STEMI patients who underwent emergency PCI treatment in hospital from January 2019 to May 2021 were selected as research objects,and divided into observation group and control group with 55 cases each randomly. After emergency PCI,on the basis of routine treatment,the observation group was treated with Xueshuantong Injection combined with rhBNP, and the control group was treated with rhBNP alone. Measured two groups' cardiac ultrasound indexes[left ventricular end diastolic volume and left ventricular end systolic volume(LVEDV and LVESV),left ventricular ejection fraction(LVEF)],hemodynamic parameters[cardiac output (CO),left ventricular stroke work (LSW),mean arterial pressure (MAP),as well as serum N-terminal B-type natriuretic peptide (NT-proBNP),growth differentiation factor 15 (GDF-15),soluble suppression of tumorigenicity 2 (sST2) and galectin 3 (Gal-3) levels before and after treatment. Occurrence of major adverse cardiac events (MACE) within 6 months after PCI was counted. And the side effects of the two groups were compared.[Results] After treatment,LVEDV and LVESV in the two groups were significantly decreased compared with before treatment (P<0.05),and LVEF was significantly increased compared with before treatment (P<0.05). LVEDV, LVESV and LVEF in observation group were significantly better than those in control group (P<0.05). After treatment,CO and LSW and MAP in the two groups were significantly increased compared with before treatment(P<0.05). CO,LSW and MAP in observation group were significantly higher than those in control group(P<0.05). After treatment,the serum concentrations of GDF-15,sST2,Gal-3 and NT-proBNP in the two groups were significantly decreased compared with before treatment (P<0.05). The serum levels of GDF-15,sST2,Gal-3 and NT-proBNP in the observation group were significantly lower than those in the control group (P<0.05). Within 6 months of follow-up after PCI,the incidence of MACE in observation group was 5.45%(3/55),which was significant lower than that in control group[18.18% (10/55),P<0.05]. The adverse reaction rate of observation group was 12.73%(7/55),which was no statistical different from that of the control group[9.09%(5/55),P>0.05].[Conclusion] Xueshuantong Injection combined with rhBNP treatment can effectively down-regulate the serum NT-proBNP,GDF-15,sST2 and Gal-3 expression levels in STEMI patients after emergency PCI,and improve after post-PCI hemodynamics and cardiac function,and reduce postoperative MACE with good safety.