芪苈强心胶囊联合曲美他嗪保护心肌缺血再灌注损伤的作用机制
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摘要
目的:芪苈强心胶囊联合曲美他嗪保护患者心肌缺血再灌注损伤的作用机制。方法:选取100例行急诊经皮冠状动脉介入治疗术患者,随机分为曲美他嗪治疗组,芪苈强心胶囊和曲美他嗪(联合治疗组)。分别于手术前、术后6 h、术后24 h检测肌酸激酶同工酶(CKMB)、心肌肌钙蛋白I(cTnI)、丙二醛(MDA)、超氧化物歧化酶(SOD)。检测患者治疗前后患者血液流变学水平及血管内皮功能变化。结果:实验组和对照组患者术后6 h和术后24 h体内CKMB和cTnI含量显著升高且实验组患者内CKMB和cTnI含量上升更加明显P<0.05)。实验组和对照组患者术后6 h和术后24 h体内MDA含量显著升高,且实验组患者内MDA含量上升更加明显(P<0.05)。实验组和对照组患者术后6 h和术后24 h体内SOD含量显著降低,且实验组患者内SOD含量降低更加明显(P<0.05)。实验组和对照组患者术后1个月心脏指数(CI)、心排血量(CO)、左室射血分数(LVEF)显著升高,且实验组患者内CI、CO和LVEF上升更加明显(P<0.05)。实验组和对照组患者术后1个月左室舒张末内径(LVEDd)显著降低,且实验组患者内LVEDd下降更加明显(P<0.05)。观察组和对照组患者血清mTOR和ET含量在治疗后显著降低,NO和AMPK含量在治疗后显著升高(P>0.05)。对照组血管内皮功能比较,观察组的改善程度更为明显(P<0.05)。与对照组相比,观察组患者心绞痛和心肌梗死患者例数明显减少,观察组的不良结果明显低于对照组(P<0.05)。结论:芪苈强心胶囊联合曲美他嗪可以明显减轻心肌缺血再灌注损伤,具有较好的心肌保护作用,芪苈强心胶囊联合曲美他嗪可以通过激活AMPK信号通路缓解心肌缺血再灌注损伤。
Objective: To prevent the mechanism of myocardial ischemia-reperfusion injury in patients with Qili Qiangxin Capsule combined with trimetazidine. Methods: 100 emergency percutaneous coronary intervention patients were treated in hospital. They were randomized to the trimetazidine-treated group(control group), Qili Qiangxin Capsule and trimetazidine combination treatment group(experimental group). Creatine kinase isoenzyme(CKMB), cardiac troponin I(cTnI), malondialdehyde(MDA) and superoxide dismutase(SOD) were measured before surgery, 6 h and 24 h after surgery. Blood rheology and endothelial function changes were measured before and after treatment. Results:The levels of CKMB and cTnI in the experimental group and control gorup were significantly increased 6 h and 24 h after surgery. The CKMB and cTnI levels in the experimental group were significantly increased(P<0.05). MDA content in the experimental group and the control gorup increased significantly at 6 h and 24 h after surgery, and the MDA content in the experimental group increased significantly(P<0.05). The levels of SOD in the experimental group and the control gorup were significantly lower at 6 h and 24 h after surgery, and the SOD content in the experimental group was significantly lower(P<0.05). The heart index(CI), cardiac output(CO) and left ventricular ejection fraction(LVEF) were significantly increased in the experimental group and the control gorup at 1 month after operation, and the CI, CO, and LVEF increased significantly in the experimental group.(P<0.05). The left ventricular end diastolic diameter(LVEDd) was significantly lower in the experimental group and the control gorup at 1 month after operation, and the LVEDd decreased significantly in the experimental group(P<0.05). Serum mTOR and ET levels in the experimental group and the control gorup were significantly decreased after treatment, and NO and AMPK levels were significantly increased after treatment(P>0.05). Compared with the control gorup, the degree of improvement in the experimental group was more obvious(P<0.05). Compared with the control gorup, the number of patients with angina pectoris and myocardial infarction was significantly reduced in the experimental group, and the adverse results in the experimental group were significantly lower than those in the control gorup(P<0.05). Conclusion:Qili Qiangxin Capsule combined with trimetazidine can significantly reduce myocardial ischemia-reperfusion injury and has a good myocardial protective effect. Qili Qiangxin Capsule combined with trimetazidine can relieve myocardial ischemia by activating AMPK signaling pathway.
Objective: To prevent the mechanism of myocardial ischemia-reperfusion injury in patients with Qili Qiangxin Capsule combined with trimetazidine. Methods: 100 emergency percutaneous coronary intervention patients were treated in hospital. They were randomized to the trimetazidine-treated group(control group), Qili Qiangxin Capsule and trimetazidine combination treatment group(experimental group). Creatine kinase isoenzyme(CKMB), cardiac troponin I(cTnI), malondialdehyde(MDA) and superoxide dismutase(SOD) were measured before surgery, 6 h and 24 h after surgery. Blood rheology and endothelial function changes were measured before and after treatment. Results:The levels of CKMB and cTnI in the experimental group and control gorup were significantly increased 6 h and 24 h after surgery. The CKMB and cTnI levels in the experimental group were significantly increased(P<0.05). MDA content in the experimental group and the control gorup increased significantly at 6 h and 24 h after surgery, and the MDA content in the experimental group increased significantly(P<0.05). The levels of SOD in the experimental group and the control gorup were significantly lower at 6 h and 24 h after surgery, and the SOD content in the experimental group was significantly lower(P<0.05). The heart index(CI), cardiac output(CO) and left ventricular ejection fraction(LVEF) were significantly increased in the experimental group and the control gorup at 1 month after operation, and the CI, CO, and LVEF increased significantly in the experimental group.(P<0.05). The left ventricular end diastolic diameter(LVEDd) was significantly lower in the experimental group and the control gorup at 1 month after operation, and the LVEDd decreased significantly in the experimental group(P<0.05). Serum mTOR and ET levels in the experimental group and the control gorup were significantly decreased after treatment, and NO and AMPK levels were significantly increased after treatment(P>0.05). Compared with the control gorup, the degree of improvement in the experimental group was more obvious(P<0.05). Compared with the control gorup, the number of patients with angina pectoris and myocardial infarction was significantly reduced in the experimental group, and the adverse results in the experimental group were significantly lower than those in the control gorup(P<0.05). Conclusion:Qili Qiangxin Capsule combined with trimetazidine can significantly reduce myocardial ischemia-reperfusion injury and has a good myocardial protective effect. Qili Qiangxin Capsule combined with trimetazidine can relieve myocardial ischemia by activating AMPK signaling pathway.
引文
[1] 王一茗,杨晓月,束彦页,等.穴位埋线对心肌缺血再灌注过程自噬相关蛋白表达的影响[J].江苏大学学报(医学版),2017,27(1):1-4.
[2] 史云燕,沈俐,高硕,等.人脐带间质干细胞来源的外切体对大鼠心肌细胞缺血/再灌注损伤的作用[J].江苏大学学报(医学版),2012,22(4):277-281.
[3] 刘锦源,司林杰.酒石酸布托啡诺预处理对小鼠心肌缺血再灌注损伤的保护作用及其机制[J].东南大学学报(医学版),2017,36(1):74-77.
[4] 柴青,张可贤,唐育民,等.远端缺血预处理及创伤预处理对缺血再灌注损伤心肌的保护作用及抗氧化能力的比较[J].东南大学学报(医学版),2018,37(2):319-324.
[5] 赵季红,孙婧,赵鹏,等.经微导管注射不同药物对急诊经皮冠状动脉介入治疗术中无复流现象的疗效研究[J].生物医学工程与临床,2014,18 (4):369-373.
[6] 余强,张大东.曲美他嗪对冠状动脉介入术后心肌缺血再灌注损伤的保护作用研究[J].蚌埠医学院学报,2012,37(4):418-421.
[7] 李美霞,田毅,符白嫩,等.阿魏酸钠和曲美他嗪联合预处理对心肌缺血再灌注损伤的保护作用[J].中国体外循环杂志,2012,10(3):133-135,140.
[8] 马瑞松,江洪,李元红,等.青蒿素抑制心肌缺血再灌注中的细胞凋亡[J].现代医学,2016,44(7):919-922.
[9] 杜海霞.辛伐他汀联合曲美他嗪对慢性心力衰竭患者心肌重塑指标及细胞因子表达水平的影响[J].现代医学,2016,44(11):1555-1559.
[10] 段丽芳.2014—2016年北京大学深圳医院曲美他嗪处方的使用情况分析[J].现代药物与临床,2017,32(3):514-518.
[11] 吴钦钦,戚本玲,王倩,等.曲美他嗪对内皮祖细胞氧化应激损伤的保护作用研究[J].中国医院药学杂志,2016,36(10):829-832,847.
[12] 刘波,郭莉,程波,等.曲美他嗪联合运动疗法对冠心病经皮冠状动脉介入术后患者心脏康复的影响[J].中国医院药学杂志,2017,37(4):376-379.
[13] 胡运勤,李丽娜.芪苈强心胶囊联合吲达帕胺治疗高血压心力衰竭的临床研究[J].现代药物与临床,2017,32(6):1013-1016.
[14] 陈东运,孙红蕾,饶雷萍.芪苈强心胶囊联合丹参酮Ⅱ_A磺酸钠治疗心肌梗死的临床研究[J].现代药物与临床,2018,33(2):260-263.
[15] 苏楠.芪苈强心胶囊联合奥普力农治疗慢性充血性心力衰竭的临床研究[J].现代药物与临床,2018,33(1):69-73.
[16] 景月月,白宏兴,梁延宏,等.芪苈强心胶囊联合重组人脑利钠肽治疗扩张型心肌病心力衰竭的临床研究[J].现代药物与临床,2017,32(10):1840-1843.
[17] 陈雁,闫玉琴.芪苈强心胶囊联合坎地沙坦酯治疗慢性肺心病急性加重期的疗效观察[J].现代药物与临床,2017,32(7):1255-1258.
[18] 许宽,龚少愚.慢性心力衰竭中医药治疗新进展[J].四川中医,2013,31(4):146-148.
[19] 毕莹,刘新林,刘小伟,等.曲美他嗪对急性前壁心肌梗死心肌缺血再灌注损伤的保护作用[J].武警医学,2017,28(10):988-991.
[20] 桑文凤,桑桂梅,赵习德,等.曲美他嗪对老年缺血性心肌病患者缺血心肌的能量代谢及心脏功能的影响[J].中国老年学杂志,2014,34(4):915-917.
[21] 李笃军,车永恒,鞠建伟,等.缺血修饰白蛋白、NT-proBNP和高敏肌钙蛋白I联合检测在急性心肌缺血早期诊断中的临床应用价值[J].标记免疫分析与临床,2016,23(11):1254-1256.
[22] 陈强,张小威,姚蕾,等.血小板及心肌肌钙蛋白检测在冠心病患者临床诊治中的价值[J].检验医学与临床,2018,15(13):2002-2004.
[23] 董富宏,梁海侠.芪苈强心胶囊对糖尿病合并心力衰竭患者心功能及血管内皮功能的改善作用[J].现代中西医结合杂志,2015,24(25):2792-2793.
[24] 于春泉,李欣桐,史芳,等.芪苈强心胶囊对心气虚型慢性心力衰竭大鼠心肌腺苷酸含量的影响[J].中国实验方剂学杂志,2012,18(3):174-177.
[25] 马方兰.疏血通对慢性阻塞性肺疾病合并肺动脉高压患者凝血状态及血清NO、NOS水平的影响[J].标记免疫分析与临床,2017,24(12):1414-1418,1426.
[26] 刘卫华,赵印平,莫江英,等.冠状动脉介入治疗对缺血性心肌病患者心功能和预后的影响[J].现代中西医结合杂志,2015,24(14):1486-1488.
[27] 何洪月,岳丽,李秀霞,等.麝香保心丸联合曲美他嗪治疗老年缺血性心肌病心力衰竭的疗效观察[J].中国全科医学,2010,13(18):2034-2035.
[28] 张国天,陈永生,梁海军,等.曲美他嗪联合辛伐他汀对老年缺血性心肌病患者心功能的改善作用[J].中国老年学杂志,2013,33(4):906-907.
[2] 史云燕,沈俐,高硕,等.人脐带间质干细胞来源的外切体对大鼠心肌细胞缺血/再灌注损伤的作用[J].江苏大学学报(医学版),2012,22(4):277-281.
[3] 刘锦源,司林杰.酒石酸布托啡诺预处理对小鼠心肌缺血再灌注损伤的保护作用及其机制[J].东南大学学报(医学版),2017,36(1):74-77.
[4] 柴青,张可贤,唐育民,等.远端缺血预处理及创伤预处理对缺血再灌注损伤心肌的保护作用及抗氧化能力的比较[J].东南大学学报(医学版),2018,37(2):319-324.
[5] 赵季红,孙婧,赵鹏,等.经微导管注射不同药物对急诊经皮冠状动脉介入治疗术中无复流现象的疗效研究[J].生物医学工程与临床,2014,18 (4):369-373.
[6] 余强,张大东.曲美他嗪对冠状动脉介入术后心肌缺血再灌注损伤的保护作用研究[J].蚌埠医学院学报,2012,37(4):418-421.
[7] 李美霞,田毅,符白嫩,等.阿魏酸钠和曲美他嗪联合预处理对心肌缺血再灌注损伤的保护作用[J].中国体外循环杂志,2012,10(3):133-135,140.
[8] 马瑞松,江洪,李元红,等.青蒿素抑制心肌缺血再灌注中的细胞凋亡[J].现代医学,2016,44(7):919-922.
[9] 杜海霞.辛伐他汀联合曲美他嗪对慢性心力衰竭患者心肌重塑指标及细胞因子表达水平的影响[J].现代医学,2016,44(11):1555-1559.
[10] 段丽芳.2014—2016年北京大学深圳医院曲美他嗪处方的使用情况分析[J].现代药物与临床,2017,32(3):514-518.
[11] 吴钦钦,戚本玲,王倩,等.曲美他嗪对内皮祖细胞氧化应激损伤的保护作用研究[J].中国医院药学杂志,2016,36(10):829-832,847.
[12] 刘波,郭莉,程波,等.曲美他嗪联合运动疗法对冠心病经皮冠状动脉介入术后患者心脏康复的影响[J].中国医院药学杂志,2017,37(4):376-379.
[13] 胡运勤,李丽娜.芪苈强心胶囊联合吲达帕胺治疗高血压心力衰竭的临床研究[J].现代药物与临床,2017,32(6):1013-1016.
[14] 陈东运,孙红蕾,饶雷萍.芪苈强心胶囊联合丹参酮Ⅱ_A磺酸钠治疗心肌梗死的临床研究[J].现代药物与临床,2018,33(2):260-263.
[15] 苏楠.芪苈强心胶囊联合奥普力农治疗慢性充血性心力衰竭的临床研究[J].现代药物与临床,2018,33(1):69-73.
[16] 景月月,白宏兴,梁延宏,等.芪苈强心胶囊联合重组人脑利钠肽治疗扩张型心肌病心力衰竭的临床研究[J].现代药物与临床,2017,32(10):1840-1843.
[17] 陈雁,闫玉琴.芪苈强心胶囊联合坎地沙坦酯治疗慢性肺心病急性加重期的疗效观察[J].现代药物与临床,2017,32(7):1255-1258.
[18] 许宽,龚少愚.慢性心力衰竭中医药治疗新进展[J].四川中医,2013,31(4):146-148.
[19] 毕莹,刘新林,刘小伟,等.曲美他嗪对急性前壁心肌梗死心肌缺血再灌注损伤的保护作用[J].武警医学,2017,28(10):988-991.
[20] 桑文凤,桑桂梅,赵习德,等.曲美他嗪对老年缺血性心肌病患者缺血心肌的能量代谢及心脏功能的影响[J].中国老年学杂志,2014,34(4):915-917.
[21] 李笃军,车永恒,鞠建伟,等.缺血修饰白蛋白、NT-proBNP和高敏肌钙蛋白I联合检测在急性心肌缺血早期诊断中的临床应用价值[J].标记免疫分析与临床,2016,23(11):1254-1256.
[22] 陈强,张小威,姚蕾,等.血小板及心肌肌钙蛋白检测在冠心病患者临床诊治中的价值[J].检验医学与临床,2018,15(13):2002-2004.
[23] 董富宏,梁海侠.芪苈强心胶囊对糖尿病合并心力衰竭患者心功能及血管内皮功能的改善作用[J].现代中西医结合杂志,2015,24(25):2792-2793.
[24] 于春泉,李欣桐,史芳,等.芪苈强心胶囊对心气虚型慢性心力衰竭大鼠心肌腺苷酸含量的影响[J].中国实验方剂学杂志,2012,18(3):174-177.
[25] 马方兰.疏血通对慢性阻塞性肺疾病合并肺动脉高压患者凝血状态及血清NO、NOS水平的影响[J].标记免疫分析与临床,2017,24(12):1414-1418,1426.
[26] 刘卫华,赵印平,莫江英,等.冠状动脉介入治疗对缺血性心肌病患者心功能和预后的影响[J].现代中西医结合杂志,2015,24(14):1486-1488.
[27] 何洪月,岳丽,李秀霞,等.麝香保心丸联合曲美他嗪治疗老年缺血性心肌病心力衰竭的疗效观察[J].中国全科医学,2010,13(18):2034-2035.
[28] 张国天,陈永生,梁海军,等.曲美他嗪联合辛伐他汀对老年缺血性心肌病患者心功能的改善作用[J].中国老年学杂志,2013,33(4):906-907.
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