文章摘要
比伐卢定对急性冠状动脉综合征患者介入术后内皮损伤和炎性反应的影响
Effect of bivalirudin on endothelial injury and inflammatory reaction after PCI in patients with acute coronary syndrome
投稿时间：2017-01-03  
DOI：10.3969/j.issn.1000-0399.2017.08.017
中文关键词: 比伐卢定  急性冠状动脉综合征  介入手术  内皮损伤  炎性反应
英文关键词: Bivalirudin  Acute coronary syndrome  Interventional surgery  Endothelial injury  Inflammatory reaction
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作者单位
王伟民 473000 河南南阳 郑州大学附属南阳市中心医院心血管内科 
王涵 473000 河南南阳 郑州大学附属南阳市中心医院医务科 
李征 473000 河南南阳 郑州大学附属南阳市中心医院泌尿外科 
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中文摘要:
      目的 探究比伐卢定对急性冠状动脉综合征（ACS）患者介入术后内皮损伤和炎性反应的影响。方法 选取2015年2月至2016年3月南阳市中心医院收治的90例行PCI患者，随机数表法分为观察组与对照组各45例。对照组采用常规肝素治疗，观察组则采用比伐卢定治疗。对比两组手术前后内皮损伤指标[血浆内皮素1（ET-1）、一氧化氮（NO）、血浆血管性假血友病因子（vWF）]、炎性指标[白介素-18（IL-18）、白介素-10（IL-10）、超敏C反应蛋白（hs-CRP）]、心功能指标[左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）、左心室射血分数（LVEF）、脑钠肽（BNP）]变化及心脑血管不良事件发生率。结果 术前，两组患者内皮指标比较，差异无统计学意义（P>0.05），术后24 h，观察组ET-1及vWF水平均低于对照组[（68.37±6.17）ng/L vs（101.83±10.24）ng/L、（514.33±86.57）U/L vs（588.92±98.46）U/L]，观察组NO水平高于对照组[（72.42±7.06）mmol/L vs（58.26±6.49）mmol/L]，差异均有统计学意义（P<0.05）。观察组IL-18水平（53.84±23.67）pg/mL、hs-CRP水平（7.22±2.74）mg/L、LVEDV水平（88.63±10.24）mL、LVESV水平（32.47±4.26）mL及BNP水平（74.82±7.94）ng/L均低于对照组IL-18水平（73.58±26.79）pg/mL、hs-CRP水平（8.67±3.56）mg/L、LVEDV水平（95.16±9.58）mL、LVESV水平（44.83±5.72）mL及BNP水平（163.51±15.44）ng/L，IL-10水平（43.61±6.08）pg/mL及LVEF水平（51.82±10.19）%高于对照组IL-10水平（33.56±4.18）pg/mL及LVEF水平（39.14±9.28）%，差异有统计学意义（P<0.05）。两组患者术后1个月心脑血管不良事件发生率比较，差异无统计学意义（P>0.05）。结论 ACS患者术后采用比伐卢定治疗可有效缓解内皮损伤，同时可降低炎性反应，恢复心功能，治疗安全性高。
英文摘要:
      Objective To explore the effect of bivalirudin on endothelial injury and inflammatory reaction after percutaneous coronary intervention (PCI) in those patients with acute coronary syndrome (ACS). Methods 90 cases of ACS patients, underwent PCI in our hospital from Feb 2015 to Mar 2016, were collected and randomly divided into two groups, with 45 cases in each group. The control group was given routine heparin treatment, and the study group was administered bivalirudin treatment. Changes of endothelial injury indexes, including plasma endothelin 1 (ET-1), nitric oxide (NO) and von Willebrand factor (vWF), and inflammatory indicators, including interleukin-8 (IL-18), interleukin-10 (IL-10) and high-sensitive C reactive protein (hs-CRP), and cardiac function indexes, including left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), left ventricular ejection fraction (LVEF) and brain natriuretic peptide (BNP), together with incidence of cardiovascular and cerebrovascular adverse events between the two groups were compared before and after the PCI operation. Results Before surgery, there was no statistically significant difference in the endothelial injury indexes between the two groups (P>0.05). At 24 h after surgery, the levels of ET-1 and vWF in the study group were lower than those in the control group[(68.37±6.17) vs (101.83±10.24) ng/L, (514.33±86.57) vs (588.92±98.46) U/L], but the level of NO in the study group was higher than that in the control group[(72.42±7.06) vs (58.26±6.49) mmol/L], and their differences were statistically significant (all P<0.05). The levels of IL-18, hs-CRP, LVEDV, LVESV and BNP in the study group were significantly lower than those in the control group[(53.84±23.67) vs (73.58±26.79) pg/mL, (7.22±2.74) vs (8.67±3.56) mg/L, (88.63±10.24) vs (95.16±9.58) ml, (32.47±4.26) vs (44.83±5.72) ml, (74.82±7.94) vs (163.51±15.44) ng/L], but the levels of IL-10 and LVEF in the study group were significantly higher than those in the control group[(43.61±6.08) vs (33.56±4.18) pg/mL, (51.82±10.19) vs (39.14±9.28)%](all P<0.05). No significant difference was found in the incidence of cardiovascular and cerebrovascular adverse events at 1 month after surgery between the two groups (P>0.05). Conclusion For the ACS patients after surgery, treatment with bivalirudin can effectively relieve endothelial injury, reduce inflammatory reaction and restore cardiac function, with higher clinical safety.
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