标题：替罗非班对冠心病PCI术患者血管内皮功能及MMP-9的影响

      作者：雷晓敏，曹蕊    陕西省核工业二一五医院心血管内科，陕西 咸阳 712000

      卷次： 2019年30卷22期

      【摘要】 目的 探讨替罗非班术前应用对冠心病经皮冠状动脉介入治疗(PCI)术患者血管内皮功能及基质金属蛋白酶-9 (MMP-9)的影响。方法 选择2017年1月至2019年1月陕西省核工业二一五医院心血管内科接诊的100例拟行PCI术的冠心病患者，按随机数表法分为观察组和对照组，每组50例，对照组在PCI术前给予低分子肝素100 U/kg静脉推注，在冠状动脉造影时给予负荷剂量替罗非班10 μg/kg的静脉推注，之后以0.15 μg·kg-1·min-1的速度持续泵入48 h，观察组患者于入院明确诊断为冠心病后即刻给予替罗非班治疗，剂量和用药方式和对照组相同。比较两组患者术前、术后3 d时的血管内皮功能、血清MMP-9、不良心血管事件及出血并发症发生率。结果 术后3 d，观察组患者的血清内皮素(ET-1)为(55.04±4.72) pg/mL，明显低于对照组的(67.81±5.60) pg/mL，一氧化氮(NO)为(51.37±4.50) μmol/L，明显高于对照组的(43.64±4.21) μmol/L，差异均有统计学意义(P<0.05)；术后 3 d，观察组患者的血清MMP-9为(279.84±22.41) mg/L，明显低于对照组的(310.35±27.59) mg/L，差异有统计学意义(P<0.05)；观察组术后28 d内的亚急性支架内血栓、紧急冠状动脉血运重建、再发心肌梗死、心律失常、脑卒中总发生率为6.0%，明显低于对照组的20.0%，差异有统计学意义(P<0.05)；观察组患者的皮肤黏膜、消化道、呼吸道出血及血尿总发生率为 14.0%，与对照组的 12.0%比较差异无统计学意义(P>0.05)。结论 替罗非班术前应用可有效改善冠心病患者PCI术后血管内皮功能及MMP-9，降低不良心血管事件发生率，且不增加出血并发症，值得临床推广应用。
      【关键词】 替罗非班；冠心病；经皮冠状动脉介入治疗；血管内皮功能；基质金属蛋白酶-9
      【中图分类号】 R541.4 【文献标识码】 A 【文章编号】 1003—6350（2019）22—2872—04

Effect of tirofiban on vascular endothelial function and MMP-9 in patients with coronary heart diseaseundergoing PCI.
LEI Xiao-min, CAO Rui. Department of Cardiovascular Medicine, Shaanxi Province Nuclear Industry215 Hospital, Xianyang 712000, Shaanxi, CHINA
【Abstract】 Objective To study the effect of tirofiban on vascular endothelial function and matrix metallopro-teinase-9 (MMP-9) in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI).Methods A total of 90 patients of coronary heart disease scheduled for PCI, who received therapy in Department ofCardiovascular Medicine, Shaanxi Province Nuclear Industry 215 Hospital from January 2017 to January 2019 were se-lected and divided into the observation group and control group according to random number table method, with 50 cas-es in each group. The control group received intravenous injection of low molecular weight heparin 100 U/kg beforePCI, and intravenous injection of tirofiban 10 μg/kg-1·min-1 at load dose during coronary angiography, and pumped con-tinuously for 48 hours at a speed of 0.15 μg/kg/min, while the observation group received irofiban after the patients werediagnosed as coronary heart disease after admission, and the dosage and mode of administration were the same as thosein the control group. The vascular endothelial function, serum MMP-9, adverse cardiovascular events, and bleeding com-plications were compared between the two groups at pre-operative and 3 d after operation. Results Three days after op-