曾凯东,谢莲娜,刘灿章,蒋梦,王丽君,魏显敬,解泽宙,王凯君

• 1:大连大学附属中山医院循环四科

摘要(Abstract)：

目的探讨肢体远隔缺血适应(RIC)对成功行经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者冠状动脉微循环灌注及亚硝酸盐(Nitrite)水平的影响。方法选取2016年1月至2017年7月在大连大学附属中山医院行直接PCI的STEMI患者75例,根据随机数字表法按2:1对照原则分为肢体RIC组50例和对照组25例。比较两组患者术后校正的TIMI帧数(CTFC)、术后1 h ST段回落率(STR)的差异,PCI术前及术后血清Nitrite水平的变化,分析肢体RIC组术后Nitrite与CTFC的相关性。结果肢体RIC组CTFC显著低于对照组[(18.12±6.4)帧比(26.04±8.55)帧,P<0.001],而STR≥70%百分率显著高于对照组(88%比64%,P=0.014),差异均有统计学意义;肢体RIC组患者Nitrite水平术后显著大于术前[(16.22±4.96)μmol/L比(10.55±4.37)μmol/L,P<0.001],且术后Nitrite水平显著高于对照组[(16.22±4.96)μmol/L比(13.01±4.16)μmol/L,P=0.007],差异均有统计学意义。Pearson相关性分析显示,肢体RIC组术后血清Nitrite水平与CTFC呈负相关(r=–0.447,P=0.001)。结论肢体RIC能改善成功行PCI的STEMI患者冠状动脉微循环灌注,增加外周血Nitrite水平参与肢体RIC改善冠状动脉微循环的作用。

关键词(KeyWords)： 肢体远隔缺血适应;心肌梗死;冠状动脉微循环

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 曾凯东,谢莲娜,刘灿章,蒋梦,王丽君,魏显敬,解泽宙,王凯君

参考文献(References)：

• [1]杜健鹏,史大卓.冠状动脉微血管功能障碍的研究进展.心血管病学进展,2010,31(3):406-409.
• [2]Prunier F,Angoulvant D,Saint Etienne C,et al.The RIPOST-MI study,assessing remote ischemic perconditioning alone or in combination with local ischemic ostconditioning in ST-segment elevation myocardial infarction.Basic Res Cardiol,2014,109(2):400.
• [3]Eitel I,Stiermaier T,Rommel KP,et al.Cardioprotection by combined intrahospital remote ischaemic perconditioning and postconditioning in ST-elevation myocardial infarction:the randomized LIPSIA CONDITIONING trial.Eur Heart J,2015,36(44):3049-3057.
• [4]Mcleod SL,Iansavichene A,Cheskes S.Remote ischemic perconditioning to reduce reperfusion injury during acute ST-segment-elevation myocardial infarction:a systematic review and Meta-analysis.J Am Heart Assoc,2017,6(5).pii:e005522.
• [5]Man C,Gong D,Zhou Y,et al.Meta-analysis of remote ischemic conditioning in patients with acute myocardial infarction.Sci Rep,2017,7:43529.
• [6]Shimizu M,Tropak M,Diaz RJ,et al.Transient limb ischaemia remotely preconditions through a humoral mechanism acting directly on the myocardium:evidence suggesting cross-species protection.Clin Sci(Lond),2009,117(5):191-200.
• [7]Gonzalez FM,Shiva S,Vincent PS,et al.Nitrite anion provides potent cytoprotective and antiapoptotic eff ects as adjunctive therapy to reperfusion for acute myocardial infarction.Circulation,2008,117(23):2986-2994.
• [8]Stokes KY,Dugas TR,Tang Y,et al.Dietary nitrite prevents hypercholesterolemic microvascular inflammation and reverses endothelial dysfunction.Am J Physiol Heart Circ Physiol,2009,296(5):H1281-H1288.
• [9]Rassaf T,Totzeck M,Hendgencotta UB,et al.Circulating nitrite contributes to cardioprotection by remote ischemic preconditioning.Circ Res,2014,114(10):1601-1610.
• [10]李萌玫,邵一兵,张纯全,等.2型糖尿病血糖控制不良合并急性心肌梗死患者择期经皮冠状动脉介入治疗后冠状动脉微循环及近期预后.中国介入心脏病学杂志,2017,25(11):628-633.
• [11]李轶男,王萍,陈晖.冠状动脉微循环障碍对心肌纤维化的影响及研究现状.中国介入心脏病学杂志,2018,26(8):468-471.
• [12]Beltrame JF.Coronary microvascular dysfunction in acute STelevation myocardial infarction.Coron Artery Dis,2017,28(1):3-4.
• [13]朱淑贤,钱菊英.冠状动脉微循环灌注障碍和冠脉无复流机理研究.中国微循环,2004,8(5):267-269.
• [14]蒋启荣,任法新,方毅民,等.CTFC对STEMI行急诊PCI后心肌血流灌注的诊断价值.泰山医学院学报,2007,28(10):784-786.
• [15]杨剑峰,王相智,张鸿举.急性心肌梗死冠状动脉介入治疗后心电图ST段回落与心肌组织灌注的观察.海南医学,2008,19(3):16-17.
• [16]王宁,王贵松,于海奕,等.远隔缺血后适应在急性ST段抬高型心肌梗死直接经皮冠状动脉介入治疗术中的心肌保护作用.北京大学学报(医学版),2014,46(6):838-843.
• [17]Pickard JM,Btker HE,Crimi G,et al.Remote ischemic conditioning:f rom experimental observation to clinical application:report from the 8th biennial hatter cardiovascular institute workshop.Basic Res Cardiol,2015,110(1):453.
• [18]Cherif-Sayadi A,Ayed-Tka KH,Zaouali MA,et al.Nitrite enhances liver graft protectio-n against cold ischemia reperfusion injury through a NOS independent pathway.Libyan J Med,2017,12(1):1308780.
• [19]Gonzalez FM,Shiva S,Vincent PS,et al.Nitrite anion provides potent cytoprotective and antiapoptotic eff ects as adjunctive therapy to reperfusion for acute myocardial infarction.Circulation,2008,117(23):2986-2994.
• [20]Liu X,Huang Y,Pokreisz P,et al.Nitric oxide inhalation improves microvascular fl ow and decreases infarction size after myocardial ischemia and reperfusion.J Am Coll Cardiol,2007,50(8):808-817.
• [21]Mcnulty PH,Scott S,Kehoe V,et al.Nitrite consumption in ischemic rat heart catalyzed by distinct blood-borne and tissue factors.Am J Physiology Heart Circ Physiol,2008,295(5):H2143-H2148.
• [22]Rassaf T,Totzeck M,Hendgen-Cotta UB,et al.Circulating nitrite contributes to cardioprotection by remote ischemic preconditioning.Circ Res,2014,114(10):1601-1610.