标题：胺碘酮联合氯吡格雷治疗急性心肌梗死的疗效及对患者免疫功能和炎症因子的影响

      作者：黄英，冯正航，李科    柳州市潭中人民医院心血管内科，广西 柳州 545002

      卷次： 2020年31卷9期

      【摘要】 目的 观察胺碘酮联合氯吡格雷治疗急性心肌梗死的疗效，并探讨其对患者免疫功能和炎症因子的影响。方法 选取2016年12月至2019年1月柳州市潭中人民医院心血管内科收治的140例急性心肌梗死患者作为研究对象，按照随机数表法将患者分为对照组和观察组，每组70例。对照组患者采用单一胺碘酮治疗，观察组患者则在胺碘酮治疗的基础上联合使用氯吡格雷治疗，疗程均为7 d。于治疗前与治疗7 d后，比较两组患者的T淋巴细胞亚群(CD3+、CD4+、CD8+)表达情况，检测比较两组患者超敏C反应蛋白(hs-CRP)和N末端脑利钠肽前体(NT-proBNP)水平，并于治疗3个疗程后评价疗效。结果 观察组患者的治疗总体有效率为95.71%，明显高于对照组的84.29%，差异有统计学意义(P<0.05)；治疗后，观察组患者的CD3+、CD4+细胞比例分别为(0.72±0.08)%、(0.43±0.07)%，明显高于对照组的(0.62±0.03)%、(0.33±0.04)%，CD8+水平为(0.22±0.02)%，明显低于对照组的(0.30±0.03)%，差异均具有统计学意义(P<0.05)；治疗后，观察组患者的Hs-CRP和NT-proBNP水平分别为(6.18±2.33) ρ/(mg·L)、(1.88±0.41) ρ/(ng·L)，明显低于对照组的(9.89±2.57) ρ/(mg·L)、(2.89±0.52) ρ/(ng·L)，差异均有统计学意义(P<0.05)。结论 胺碘酮联合氯吡格雷治疗心肌梗死能有效调节患者的免疫功能，减轻炎症因子的表达，临床治疗效果显著。
      【关键词】 胺碘酮；氯吡格雷；急性心肌梗死；心功能；免疫功能；炎症反应
      【中图分类号】 R542.2+2 【文献标识码】 A 【文章编号】 1003—6350（2020）09—1103—04

Efficacy of amiodarone combined with clopidogrel in the treatment of acute myocardial infarction and its effecton patients' immune and inflammatory response.
HUANG Ying, FENG Zheng-hang, LI Ke. Department ofCardiovascular Medicine, Liuzhou Tanzhong People's Hospital, Liuzhou 545002, Guangxi, CHINA
【Abstract】 Objective To observe the curative effect of amiodarone combined with clopidogrel in the treatmentof acute myocardial infarction, and to explore its effect on patients' immune and inflammatory response, so as to provideclinical reference for the medication of myocardial infarction patients. Methods A total of 140 patients with acute myo-cardial infarction, who admitted to Department of Cardiovascular Medicine, Liuzhou Tanzhong People's Hospital fromDecember 2016 to January 2019 were selected as the study objects. The patients were divided into the control group andobservation group according to random number table method, with 70 patients in each group. The patients in the controlgroup were treated with amiodarone alone, while those in the observation group were treated with clopidogrel on the ba-sis of amiodarone. The course of treatment was 7 days. The expression of T lymphocyte subsets (CD3+, CD4+, CD8+) wascompared before and after treatment for 7 days. The levels of hs-CRP and brain natriuretic peptide precursor (NT-proB-NP) were detected and compared between the two groups. The final therapeutic effect was evaluated after 3 courses oftreatment. Results The overall effective rate of treatment in the observation group was 95.71%, which was significant-ly higher than 84.29% in the control group (P<0.05); the proportions of CD3+ and CD4+ cells in the observation groupwere (0.72±0.08)% and (0.43±0.07)%, which were significantly higher than corresponding (0.62± 0.03)% and (0.33±0.04)% in the control group (P<0.05); the CD8+ level in the observation group was (0.22±0.02)%, which was significant-ly lower than (0.30±0.03)% in the control group (P<0.05). The expression level of hs-CRP in the observation group was(6.18±2.33) ρ/(mg·L), which was significantly lower than (9.89±2.57) ρ/(mg·L) in the control group (P<0.05). Thelevel of brain NT-proBNP in the observation group was (1.88 ± 0.41) ρ/(ng·L), which was significantly lower than(2.89±0.52) ρ/(ng·L) in the control group (P<0.05). Conclusion Amiodarone combined with clopidogrel in the treat-ment of myocardial infarction can effectively regulate the immune function of patients, reduce the expression of inflam-matory factors, and the clinical treatment effect is significant.
      【Key words】 Amiodarone; Clopidogrel; Acute myocardial infarction; Cardiac function; Immune function; Inflam-matory response