阿利西尤单抗联合参芎葡萄糖注射液对急性非ST段抬高型心肌梗死PCI患者冠状动脉微循环、心血管结局的影响

Effects of alirocumab combined with Shenxiong Glucose Injection on coronary microcirculation and cardiovascular outcomes in PCI patients with acute non-ST-elevation myocardial infarction

摘要:

目的 观察急性非ST段抬高型心肌梗死（NSTEMI）经皮冠状动脉介入术（PCI）患者治疗中阿利西尤单抗联合参芎葡萄糖注射液的效果。方法 选取2023年5月—2024年2月徐州市中心医院行PCI的NSTEMI患者78例，通过区组随机化分为对照组、试验组。对照组PCI后采用阿利西尤单抗治疗，试验组在对照组基础上使用参芎葡萄糖注射液。两组均于治疗1个月后观察疗效。比较两组心功能、冠状动脉微循环指标、心肌呈色分级（MBG）、主要不良心血管事件（MACE）及不良反应。结果 PCI后1个月试验组左心房内径（LAD）、左心房容积（LAV）、左心室舒张末期内径（LVDd）均低于对照组，试验组左心室射血分数（LVEF）、二尖瓣血流频谱E/A比值（E/A）均高于对照组（P <0.05）。PCI后1个月与PCI后即刻，对照组LAD、LAV、LVEF、LVDd及E/A的差值均低于试验组（均P <0.05）。PCI后1个月试验组心肌微循环阻力指数（IMR）低于对照组，试验组冠状动脉血流储备（CFR）、瞬时无波形比值（iFR）均高于对照组（P <0.05）；PCI后1个月与PCI后即刻，对照组CFR、IMR、iFR差值均低于试验组（P <0.05）。两组术后MBG比较，试验组MBG 3级占比高于对照组（P <0.05）。两组手术前后MBG比较，术后MBG 2、3级占比高于术前（P <0.05）。试验组MACE总发生率低于对照组（P <0.05）。试验组与对照组不良反应总发生率比较，差异无统计学意义（P >0.05）。结论 阿利西尤单抗联合参芎葡萄糖注射液可改善NSTEMI患者PCI后心功能、冠状动脉微循环及心血管结局，且不增加药物不良反应。

Abstract:

Objective To observe the efficacy of alirocumab combined with Shenxiong Glucose Injection in the treatment of patients with acute non-ST-elevation myocardial infarction (NSTEMI) undergoing percutaneous coronary intervention (PCI).Methods A total of 78 NSTEMI patients undergoing PCI were randomly divided into a control group and a trial group using block randomization. The control group received alirocumab after PCI, and the trial group received additional Shenxiong Glucose Injection on the basis of the control group. The therapeutic efficacy was evaluated 1 month after treatment in both groups. Cardiac function, coronary microcirculation indexes, myocardial blush grade (MBG), major adverse cardiovascular events (MACE), and adverse reactions were compared between the two groups.Results At 1 month after PCI, there were significant differences in left atrial diameter (LAD), left atrial volume (LAV), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVDd), and mitral inflow E/A ratio (E/A) between the control group and the trial group (P < 0.05). LAD, LAV, and LVDd were lower, while LVEF and E/A were higher in the trial group than in the control group. The changes in LAD, LAV, LVEF, LVDd, and E/A from immediately after PCI to 1 month after PCI were significantly different between the two groups (P < 0.05). The changes in LAD, LAV, LVEF, LVDd, and E/A were smaller in the control group than in the trial group. At 1 month after PCI, there were significant differences in coronary flow reserve (CFR), index of microcirculatory resistance (IMR), and instantaneous wave-free ratio (iFR) between the two groups (P < 0.05). IMR was lower, while CFR and iFR were higher in the trial group than in the control group. The changes in CFR, IMR, and iFR from immediately after PCI to 1 month after PCI were significantly different between the two groups (P < 0.05). The changes in CFR, IMR, and iFR in the control group were smaller than those in the trial group. There was a significant difference in postoperative MBG between the two groups (P < 0.05), with a higher MBG in the trial group. MBG was significantly improved after surgery in both the control group and the trial group (P < 0.05). The total incidence of MACE was significantly lower in the trial group than in the control group (P < 0.05). There was no significant difference in the total incidence of adverse reactions between the two groups (P > 0.05).Conclusion Alirocumab combined with Shenxiong Glucose Injection can improve cardiac function, coronary microcirculation, and cardiovascular outcomes in NSTEMI patients after PCI without increasing adverse drug reactions.