王涟,徐标,张荣林,宋杰,张静梅,施广飞,黄为,李虎,孙步高

• 1: 南京大学医学院附属鼓楼医院心内科
• 2:南京大学医学院附属鼓楼医院心内科
• 3:南京大学医学院附属鼓楼医院心内科
• 4:南京大学医学院附属鼓楼医院心内科

摘要(Abstract)：

目的评价国产血小板膜糖蛋白(GP)Ⅱb/Ⅲa受体拮抗剂替罗非班对急性ST段抬高性心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)后心肌灌注及安全性的影响。方法2005年1月至2006年12月发病12h内接受急诊PCI术的STEMI患者中,符合术前梗死相关血管(IRA)完全闭塞(TIMI0或1级)、术后前向血流达到TIMI3级的患者共71例,分为替罗非班组(n=36)和对照组(n=35)。比较两组基础临床特征、心肌呈色分级(MBG)及术后90min心电图ST段回落百分比(sumSTR),并观察住院期间主要心血管事件、左室射血分数及出血并发症。结果两组基础临床情况和造影特征无明显差异。替罗非班组心肌呈色分级3级获得率明显增高(69·4%比37·1%,P=0·01),术后90minsum STR(60·6%±26·7%比42·2%±35·3%,P=0·03)和ST段完全回落(sumSTR≥70%)的比例(61·1%比28·6%,P=0·02)均显著高于对照组。替罗非班组心肌梗死后1周射血分数也明显高于对照组(55·2%±5·2%比51·3%±7·3%,P=0·03)。两组住院期间主要心血管事件发生率差异无统计学意义。替罗非班组轻度出血发生率有高于对照组趋势(16·7%比5·7%,P=0·26),但无严重出血或血小板减少症。结论国产替罗非班能改善急诊PCI术后心肌灌注指标,并有助于改善心功能。急诊PCI联合使用替罗非班治疗是安全可行的。

关键词(KeyWords)： 心肌梗死;血管成形术,经腔,经皮冠状动脉;血小板膜糖蛋白类;替罗非班

Abstract:

Keywords:

基金项目(Foundation): 江苏省重大科技示范工程项目(BS2003003)“心脑血管疾病规范化治疗”资助

作者(Author): 王涟,徐标,张荣林,宋杰,张静梅,施广飞,黄为,李虎,孙步高

参考文献(References)：

• [1]Ito H,Maruyama A,Iwakura K,et al.Clinical implications of the‘no reflow’phenomenon:a predictor of complications and left ventricular remodeling in reperfused anterior wall myocardial infarction.Circulation,1996,93:223-228.
• [2]Kenner MD,Zajac EJ,Kondos GT,et al.Ability of the no-re-flow phenomenon during an acute myocardial infarction to predict left ventricular dysfunction at one-month follow-up.Am J Cardi-ol,1995,76:861-868.
• [3]Yang YJ,Zhao JL,You SJ,et al.Different effect of tirofiban and aspirin plus clopidogrel on myocaridial no-reflow in a mini-swine model of acute myocardial infarction and reperfusion.Heart,2006,92:1131-1137.
• [4]Martinez-Rios MA,Rosas M,Gonalez H,et al.Comparison of reperfusion regimens with or without tirofiban in ST-elevation a-cute myocardial infarction.Am J Cardiol,2004,93:280-287.
• [5]Van t Hof AW,Liem A,Suryapranata H,et al.Angiographic as-sessment of myocardial reperfusion in patients treated with prima-ry angioplasty for acute myocardial infarction.Circulation,1998,97:2302-2306.
• [6]De Lemos JA,Antman EM,Gibson M,et al.Abciximab im-proves both epicardial flow and myocardial reperfusion in ST-ele-vation myocardial infarction.Circulation,2000,101:239-243.
• [7]Rao AK,Pratt C,Berke A,et al.Thrombolysis in Myocardial Infarction(TIMI)Trial PhraseⅠ:Hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase.J Am Coll Cardiol,1988,11:1-11.
• [8]Rezkalla SH,Kloner RA.No-reflow phenomenon.Circulation,2002,105:656-662.
• [9]Eeckhout E,Kern MJ.The coronary no-reflow phenomenon:a review of mechanisms and therapies.Eur Heart J,2001,22:729-739.
• [10]Dong J,Ndrepepa G,Schmitt C,et al.Early resolution of ST-segment elevation correlates with myocardial salvage assessed by Tc-99m sestamibi scintigraphy in patients with acute myocardial infarction after mechanical or thrombolytic reperfusion therapy.Circulation,2002,105:2946-2949.
• [11]Uyarel H,Uzunlar B,Dayi SU,et al.Effect of tirofiban therapy on ST segment resolution and clinical outcomes in patients with STsegment elevated acute myocardial infarction undergoing pri-mary angioplasty.Cardiology,2006,105:168-175.
• [12]Topol EJ,Yadav JS.Recognition of the importance of emboliza-tion in atherosclerotic vascular disease.Circulation,2000,101:570-580.
• [13]Zhao XQ,Theroux P,Snapinn SM,et al.Intracoronary thrombus and platelet glycoproteinⅡb/Ⅲa receptor blockade with tirofiban in unstable angina or non-Q-wave myocardial in-farction.Angiographic results from the PRISM-PLUS Trial.Cir-culation,1999,100:1609-1615.
• [14]De Luca G,Suryapranata H,Stone GW,et al.Abciximab as ad-junctive therapy to reperfusion in acute ST-segment elevation my-ocardial infarction:a meta-analysis of randomized trials.JAMA,2005,293:1759-1765.
• [15]Kunichika H,Ben-Yehuda O,Lafitte S,et al.Effects of glyco-proteinⅡb/Ⅲa inhibition on microvascular flow after coronary reperfusion.A quantitative myocardial contrast echocardiography study.J Am Coll Cardiol,2004,43:276-283.