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目的:观察急诊经皮冠状动脉介入治疗术(PCI)中冠状动脉内注射盐酸替罗非班,对急性ST段抬高型心肌梗死(STEMI)患者血清血栓素蛋白1(TSP-1)水平的影响。方法:急性STEMI行急诊PCI术的患者44例(男性33例,女性11例),冠脉造影显示梗死相关血管(IRA)有明显血栓征象,平均年龄(62.0±11.4)岁,随机分成替罗非班组术中冠状动脉内注射盐酸替罗非班,n=24)与对照组(n=20)。酶联免疫吸附法(ELISA)法检测血清TSP-1水平。比较两组患者PCI术中IRA的TI MI血流情况。结果:两组患者基线临床特征无统计学差异。替罗非班组PCI术中无复流的发生率明显低于对照组(4.0%比20.0%,P<0.05),IRA远端栓塞发生率低于对照组(0%比15.0%,P<0.05)。替罗非班组TSP-1增加明显;PCI术前替罗非班组TSP-1(346±145)ng/L,与对照组(339±125)ng/L比较无显著差异。两组PCI术后TSP-1水平较术前分别增加(39±11)%,(18±9)%,组间比较,P<0.05。结论:STEMI患者行急诊PCI术中,冠脉内给予替罗非班可能是TSP-1水平增加的原因之一;IRA无复流发生减少,心肌组织灌注水平增加。TSP-1水平与IRA开通后TI MI血流呈正相关,TSP-1水平增加的意义尚不明确,其与远期预后、特别是心力衰竭间的关系值得进一步研究,推测围绕TSP-1的研究或治疗有可能是新的方向。
Objective: To observe the clinical effect of Tirofiban on intracoronary injection of TSP-1 in patients with acute ST-segment elevation myocardial infarction (STEMI) during emergency percutaneous coronary intervention (PCI) influences. METHODS: Forty-four patients (33 males and 11 females) undergoing acute STEMI undergoing PCI were enrolled in this study. Coronary angiography showed significant thrombotic signs of infarct-related blood vessels (IRA) with mean age (62.0 ± 11.4 years) Non-intraoperative group intracoronary injection of tirofiban hydrochloride, n = 24) and control group (n = 20). Serum TSP-1 levels were detected by enzyme linked immunosorbent assay (ELISA). TI MI blood flow was compared between two groups of patients with IRA. Results: There was no significant difference in baseline clinical characteristics between the two groups. The incidence of no-reflow during PCI in tirofiban group was significantly lower than that in control group (4.0% vs. 20.0%, P <0.05), and the incidence of distal embolism in IRA group was lower than that in control group (0% vs 15.0%, P <0.05 ). Tirofiban group TSP-1 increased significantly; Tirofiban group before PCI TSP-1 (346 ± 145) ng / L, compared with the control group (339 ± 125) ng / L no significant difference. The levels of TSP-1 in both groups after PCI increased by (39 ± 11)% and (18 ± 9)%, respectively, compared with those before operation (P <0.05). CONCLUSIONS: Tirofiban may be one of the reasons for the increase of TSP-1 level in STEMI patients undergoing emergency PCI. There is no recurrence of IRA and myocardial perfusion in STEMI patients. TSP-1 levels are positively correlated with TI MI blood flow after IRA is switched on. The significance of increasing TSP-1 levels remains unclear. The relationship between TSP-1 levels and long-term prognosis, especially heart failure, deserves further study. Or treatment may be the new direction.