| 摘要: |
| 目的：通过测定并比较经皮冠状动脉介入治疗(PCI)手术前、后主动脉根部平均动脉压力(MAP)、血醛固酮（Aldo）、血肌钙蛋白-I（cTn-I）、脑钠肽（BNP）、C-反应蛋白（CRP）浓度的变化,探讨螺内酯预处理对PCI术后心肌保护作用的机制。
方法：将如皋市人民医院心内科2007-06至2010-12期间择期PCI患者随机分为治疗组（A组,n=116）与对照组（B组,n=121），治疗组予螺内酯口服（20-40mg/d）进行预处理，而对照组给予安慰剂。分别测定并比较二组PCI术前、术后的MAPA、Aldo、cTn-I、BNP、CRP。所有数据采用SPSS11.5软件包进行数据分析。
结果： A、B二组患者在年龄、性别比例、手术时间、球囊扩张次数、支架植入数量等方面无明显统计学差异(P>0．05)；组内比较，术后Aldo、cTn-I、BNP、 CRP均较术前有明显升高；组间比较，术前、术后Aldo无明显差异(P>0．05),A组cTn-I、CRP、BNP浓度均明显低于B组(P<0．05)，而MAP高于B组(P<0．05)；相关分析表明ΔMAP（术后-术前）与ΔcTn-I（术后/术前）、ΔCRP（术后/术前）、ΔBNP（术后/术前）呈负相关，相关系数分别为-0.69、-0.51、-0.56(P<0．05或P<0.01)。
结论：螺内酯预处理可以减轻PCI围手术期相关的心肌损害、抑制炎症反应，其机制与螺内酯可能协同Aldo的非基因组作用增加心肌灌注压有关。 |
| 关键词: 冠心病 PCI 螺内酯 肌钙蛋白-I 醛固酮 |
| DOI：10.3724/SP.J.1008.2011.0889 |
| 投稿时间：2011-04-21修订日期：2011-07-27 |
| 基金项目:南通市科技局指导性课题:S9930 |
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| Clinical research on protective effect of spironolactone which pretreatmented in period of percataneous coronary interventional(PCI) |
| 郭江宏 |
| () |
| Abstract: |
| Objective: To investigate the protective mechanism of spironolactone which pretreatmented in period of percataneous coronary interventional(PCI),by detecting the variation of mean arterial pressurein root of aorta（MAPA）, concentrations of aldosterone, Troponin I（cTn-I）, brain natriuretic peptide（BNP）and c-reaction protein(CRP).
Methods:
Patients who need to PCI in department of cardiology of Rugao people’s hospital from Junly,2007 to December,2010 were divided into two groups randomly, group of therapy (A group, n=116),group of contrast(B group, n=121).Spironolactone（20-40mg/d） was used in patients in group A ,and placebo was given to patients in group B. The levels of MAPA and the concentrations of Aldo,cTn-I,BNP ,CRP before and after PCI were detected or measured. All datas was analysed by software of SPSS11.5.
Results: There were no significant different in age, sexual, operation time, times of balloon and number of stents between two groups. The concentrations of Aldo，cTn-I，BNP and CRP were all raised up in two groups after operation; there were no great difference in the concentration of the Aldo between two groups, but concentrations of cTn-I、CRP、BNP in group A were much lower than that in group B（P<0.05） and the level of MAPA was higher than that in group B. There were obvious dependablity between ΔMAPA(postoperative MAPA -preoperative MAPA)andΔcTn-I(postoperative cTn-I / preoperative cTn-I),ΔCRP(postoperative CRP/ preoperative CRP),ΔBNP(postoperative BNP/ preoperative BNP), and coefficient correlations were 0.61、0.38、0.59(P<0．05orP<0.01)
Conclusion: Spironolactone could alleviate the injury of myocardial damage,and lessen inflammatory reaction in preoperative period of PCI. The possible pathomechanism might be related with that it could encourage the non-genomic effects of Aldo, and improve the perfusion of coronary. |
| Key words: coronary heart disease percataneous coronary interventional therapy spironolactone troponin-I aldosterone |
