急性STEMI患者直接PCI时经球囊尾部于冠状动脉内注射小剂量尿激酶原的疗效

doi:10.3969/j.issn.1004-583X.2024.06.006

摘要/Abstract

摘要：

目的探讨直接经皮冠状动脉介入术(percutaneous coronary intervention,PCI)时,经球囊尾部于冠状动脉内注射小剂量尿激酶原对急性重度血栓负荷ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者的临床疗效。方法纳入2022年6月至2023年7月就诊于天津市宝坻区人民医院胸痛中心、发病时间<12 h、直接PCI时梗死相关动脉为重度血栓负荷(血栓积分≥4分)的急性STEMI患者122例,采用随机数字表法将患者分为经球囊尾部于冠状动脉内注射尿激酶原+替罗非班组(研究组,61例)和单纯经球囊尾部于冠状动脉内注射替罗非班组(对照组,61例)。比较两组临床资料。结果 ①两组年龄、性别、吸烟史、高血压病史、糖尿病病史、冠心病家族史、陈旧性心肌梗死病史、高脂血症病史、心功能分级、术前TIMI血流分级、TMPG血流分级、术前化验(肌酸激酶同工酶、超敏肌钙蛋白T、CRP、D-二聚体、B型脑钠肽、肌酐、血红蛋白)、梗死相关动脉、病变血管支数、症状至再灌注时间和血栓负荷等差异均无统计学意义(P>0.05)。②PCI后两组TIMI血流分级、TMPG血流分级、主要心血管不良事件及出血率差异均无统计学意义(P>0.05)。③术后研究组2 h心电图ST段回降率≤50%占比、超敏肌钙蛋白T峰值浓度、肌酸激酶同工酶峰值浓度、术后24 h B型脑钠肽均低于对照组,术后1周左心室射血分数高于对照组,差异均有统计学意义(P<0.05)。结论经球囊尾部于冠状动脉内注射小剂量尿激酶原能够减少重度血栓负荷急性STEMI患者的心肌损害,改善心脏功能,并且不增加患者住院期间出血风险。

关键词: ST段抬高型心肌梗死, 经皮冠状动脉介入治疗, 重组人尿激酶原, 替罗非班, 冠脉内注射

Abstract:

Objective To explore the clinical effect of the intracoronary injections of low-dose prourokinase through the tail of the ballon on acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods A total of 122 acute STEMI patients with onset within 12 h, and emergency coronary thrombosis in infarct-related artery (IRA) with thrombus score≥4 who visited the Chest Pain Center of Tianjin Baodi Hospital from June 2022 to July 2023 were recruited. They were randomly assigned into the observation group (n=61, intracoronary injections of low-dose prourokinase and tirofiban through the tail of the ballon) and control group (n=61, intracoronary injections of tirofiban through the tail of the ballon). Clinical data of the two groups were compared. Results There were no significant differences in the age, sex, smoking history, hypertension history, diabetes history, family history of coronary heart disease, history of previous myocardial infarction, hyperlipidemia history, cardiac function classification, preoperative thrombolysis in myocardial infarction (TIMI) flow grade, TIMI myocardial perfusion grade (TMPG), preoperative laboratory testing (including creatine kinase MB [CK-MB], high-sensitive cardiac troponin T [hs-cTnT], C -reactive protein [CRP], D-dimer, B-type natriuretic peptide [BNP], creatinine, hemoglobin), IRA, number of diseased vessels, symptom to reperfusion time, and thrombus load between the two groups (P>0.05). No significant differences were found between the groups in TIMI flow grade, TMPG, and incidences of major adverse cardiovascular events (MACEs) and bleeding after PCI (P>0.05). The rate of reduced ST-segment elevation (STR%) of less than 50% (≤50%) at 2 h, peak values of hs-cTnT and CK-MB, and BNP at 24 h postoperatively were significantly lower in the observation group than those of control group, while the left ventricular ejection fraction at 1 week postoperatively was significantly higher (P<0.05).Conclusion Intracoronary injections of low-dose prourokinase through the tail of the ballon reduces myocardial damage and improves cardiac function in acute STEMI patients with severe thrombus load, without increasing the risk of bleeding during hospitalization.

Key words: ST-segment elevation myocardial infarction, percutaneous coronary intervention, recombinant Human Prourokinase for Injection, tirofiban hydrochloride, intracoronary injection

中图分类号:

R542.22

李亚楠, 张红雨. 急性STEMI患者直接PCI时经球囊尾部于冠状动脉内注射小剂量尿激酶原的疗效[J]. 临床荟萃, 2024, 39(6): 518-523.

Li Yanan, Zhang Hongyu. Clinical study of the efficacy of intracoronary injections of low-dose prourokinase through the tail of the balloon on acute ST-segment elevation myocardial infarction patients undergoing percuteneous coronary intervention[J]. Clinical Focus, 2024, 39(6): 518-523.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2024.06.006

https://huicui.hebmu.edu.cn/CN/Y2024/V39/I6/518

图/表 7

参考文献 22

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项目	研究组(n=61)	对照组(n=61)	χ²/Z/t值	P值
年龄(岁)	58.61±13.34	59.93±13.04	1.441	0.155
高血压病史[例(%)]	41(67.2)	37(60.7)	0.569	0.451
男性[例(%)]	40(65.6)	38(62.3)	0.036	0.850
糖尿病病史[例(%)]	22(36.1)	27(44.3)	0.927	0.357
高脂血症[例(%)]	15(24.6)	10(16.4)	1.258	0.262
吸烟史[例(%)]	28(45.9)	18(29.5)	3.490	0.062
陈旧性心肌梗死[例(%)]	10(16.4)	14(22.9)	0.893	0.375
冠心病家族史[例(%)]	19(31.1)	28(45.9)	1.697	0.095
Killip分级≥2级[例(%)]	4(6.5)	4(6.5)	0.000	1.000
血肌酐(μmol/L)	78.15±19.98	90.59±83.69	1.102	0.275
血红蛋白(g/L)	145.41±14.39	143.84±11.53	-0.634	0.529
CRP(mg/L)	2.50(2.50, 3.65)	2.55(2.50, 2.55)	-0.866	0.387
D-二聚体(mg/L)	0.38(0.25, 0.50)	0.43(0.19, 0.58)	-0.711	0.477
BNP(pg/ml)	23.40(13.50, 95.40)	29.90(13.50, 139.30)	-0.768	0.443
CK-MB(U/L)	3.32(1.62, 14.38)	7.60(2.01, 13.90)	-1.367	0.172
hs-cTnT(ng/L)	3.13(3.13, 3.25)	3.13(0.04, 30.99)	-0.168	0.866
IRA[例(%)]
LAD	28(45.9)	30(49.2)
LCX	5(8.2)	9(14.7)	0.000	1.000
RCA	28(45.9)	22(36.1)
病变支数[例(%)]
单支	56(91.8)	55(90.2)
双支	3(4.9)	2(3.3)	0.000	1.000
三支	2(3.3)	4(6.5)
梗死部位[例(%)]
前壁其他	23(37.7) 38(62.3)	26(42.6) 35(57.4)	0.307	0.580
血栓负荷[例(%)]
血栓积分4分血栓积分5分	37(60.7) 24(39.3)	46(75.4) 15(25.6)	2.412	0.120
TIMI血流分级[例(%)]
0级	28(45.9)	32(52.5)
1级	5(8.2)	2(3.3)	3.744	0.290
2级	6(9.8)	2(3.3)
3级	22(36.1)	25(41.0)
TMPG血流分级[例(%)]
0级	60(98.4)	59(96.7)
1级	1(1.6)	2(3.3)	0.000	1.000
2级	0(0.0)	0(0.0)
3级	0(0.0)	0(0.0)
症状至再灌注时间(min)	257.82±145.72	254.38±164.31	-0.128	0.899

项目	研究组(n=61)	对照组(n=61)	χ²/Z/t值	P值
年龄(岁)	58.61±13.34	59.93±13.04	1.441	0.155
高血压病史[例(%)]	41(67.2)	37(60.7)	0.569	0.451
男性[例(%)]	40(65.6)	38(62.3)	0.036	0.850
糖尿病病史[例(%)]	22(36.1)	27(44.3)	0.927	0.357
高脂血症[例(%)]	15(24.6)	10(16.4)	1.258	0.262
吸烟史[例(%)]	28(45.9)	18(29.5)	3.490	0.062
陈旧性心肌梗死[例(%)]	10(16.4)	14(22.9)	0.893	0.375
冠心病家族史[例(%)]	19(31.1)	28(45.9)	1.697	0.095
Killip分级≥2级[例(%)]	4(6.5)	4(6.5)	0.000	1.000
血肌酐(μmol/L)	78.15±19.98	90.59±83.69	1.102	0.275
血红蛋白(g/L)	145.41±14.39	143.84±11.53	-0.634	0.529
CRP(mg/L)	2.50(2.50, 3.65)	2.55(2.50, 2.55)	-0.866	0.387
D-二聚体(mg/L)	0.38(0.25, 0.50)	0.43(0.19, 0.58)	-0.711	0.477
BNP(pg/ml)	23.40(13.50, 95.40)	29.90(13.50, 139.30)	-0.768	0.443
CK-MB(U/L)	3.32(1.62, 14.38)	7.60(2.01, 13.90)	-1.367	0.172
hs-cTnT(ng/L)	3.13(3.13, 3.25)	3.13(0.04, 30.99)	-0.168	0.866
IRA[例(%)]
LAD	28(45.9)	30(49.2)
LCX	5(8.2)	9(14.7)	0.000	1.000
RCA	28(45.9)	22(36.1)
病变支数[例(%)]
单支	56(91.8)	55(90.2)
双支	3(4.9)	2(3.3)	0.000	1.000
三支	2(3.3)	4(6.5)
梗死部位[例(%)]
前壁其他	23(37.7) 38(62.3)	26(42.6) 35(57.4)	0.307	0.580
血栓负荷[例(%)]
血栓积分4分血栓积分5分	37(60.7) 24(39.3)	46(75.4) 15(25.6)	2.412	0.120
TIMI血流分级[例(%)]
0级	28(45.9)	32(52.5)
1级	5(8.2)	2(3.3)	3.744	0.290
2级	6(9.8)	2(3.3)
3级	22(36.1)	25(41.0)
TMPG血流分级[例(%)]
0级	60(98.4)	59(96.7)
1级	1(1.6)	2(3.3)	0.000	1.000
2级	0(0.0)	0(0.0)
3级	0(0.0)	0(0.0)
症状至再灌注时间(min)	257.82±145.72	254.38±164.31	-0.128	0.899

组别	例数	TIMI血流分级[例(%)]		TMPG血流分级[例(%)]
组别	例数	0~2级	3级	0~2级	3级
研究组	61	2(3.3)	59(96.7)	3(4.9)	58(95.1)
对照组	61	2(3.3)	59(96.7)	6(9.8)	55(90.2)
χ²值		0.000		1.080
P值		1.000		0.299

组别	例数	TIMI血流分级[例(%)]		TMPG血流分级[例(%)]
组别	例数	0~2级	3级	0~2级	3级
研究组	61	2(3.3)	59(96.7)	3(4.9)	58(95.1)
对照组	61	2(3.3)	59(96.7)	6(9.8)	55(90.2)
χ²值		0.000		1.080
P值		1.000		0.299

组别	例数	STR[例(%)]
组别	例数	≤50%	>50%
研究组	61	6(9.8)	55(90.2)
对照组	61	17(27.9)	44(72.1)
χ²值		6.483
P值		0.011