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[摘要]目的 观察GLP-1类似物利拉鲁肽在急性ST段抬高型心肌梗死患者急诊PCI治疗中的疗效和安全性。方法 选择2014年1月～2016年11月新发急性ST段抬高型心肌梗死伴入院时高血糖并行直接PCI的患者160例，将其随机分为实验组（n=80）和对照组（n=80），实验组在入选后尽早应用利拉鲁肽干预血糖，对照组采用其他方法干預血糖。观察并比较两组术后7、30、90 d的糖化血红蛋白、左室舒张末期内径，左室射血分数，同时比较两组的主要心血管事件（MACE）：可能或确定的室颤、心源性死亡、再发心绞痛、急性左心力衰竭发作、再次血运重建的发生率。结果 观察组术后30、90 d的左室舒张末期内径、左室射血分数优于对照组（P<0.05）。两组各发生心源性死亡1例，考虑可能为心脏破裂；观察组5例行再次血运重建，对照组7例术后5 d择期行非梗死相关动脉血运重建，两组的MACE发生发生率差异均无统计学意义（P>0.05）。结论 在AMI常规直接PCI及药物治疗的基础上，加用利拉鲁肽进行血糖干预可改善患者的近期左室重构，提高左室射血分数。

[关键词]利拉鲁肽；急性ST段抬高心肌梗死；急诊PCI

[中图分类号] R542.2+2 [文献标识码] A [文章编号] 1674-4721（2017）06（a）-0048-04

[Abstract]Objective To observe the efficacy and safety of Liraglutide in PCI treatment for patients with ST-elevation acute myocardial infarction.Methods 160 new patients with STEMI given emergency PCI accompanying with high blood glucose on admission treated in our hospital from January 2014 to November 2016 were selected and they were randomly divided into the experimental group （n=80） and control group （n=80）.In the experimental group，Liraglutide was used as soon as possible after being selected to intervene the blood glucose，while in the control group，other methods were used to intervene the blood glucose.The glycosylated hemoglobin，left ventricular end diastolic diameter and left ventricular ejection fraction were observed and compared between the two groups after 7，30 and 90 d operation；the incidence rate of major cardiovascular events （MACE） including possible or definite ventricular fibrillation， cardiac death，recurrent angina，acute left heart attack，and revascularization between two groups were compared.Results The left ventricular end diastolic diameter and left ventricular ejection fraction in the observation group after 30 and 90 d operation were better than those in the control group （P<0.05）.There was 1 case of cardiac death in two groups，and it can be thought as ardiac rupture，and the observation group of 5 cases underwent revascularization，7 cases in the control group were scheduled for non infarct related artery revascularization，and incidence rate of MACE between two group showed no significant difference （P>0.05）.Conclusion Based on AMI conventional direct PCI and drug treatment，Liraglutide added to conduct blood glucose intervening can improve the left ventricular remodeling recently and increase the ejection fraction of left ventricle.

[Key words]Liraglutide；ST-elevation acute myocardial infarction；Emergency percutaneous coronary intervention

大量研究证实，住院时伴有高血糖的AMI患者发生心源性休克、心力衰竭及死亡的风险远大于无高血糖者，既往无糖尿病史的应激性高血糖也是如此。对于AMI的高血糖，胰岛素治疗虽然有效，但是CCU医生常因担心导致低血糖和不明确高血糖的危害而忽视血糖管理。近年来，新的降糖药物胰升糖素样肽1（glueagon-like peptide-1，GLP-1）因其血糖依赖性降糖作用且兼具心血管保护作用而日益受到重视，本课题研究旨在通过对于入院时合并高血糖的急性ST段抬高型心肌梗死患者，在直接PCI及常规药物治疗的基础上加用GLP-1类似物利拉鲁肽（1iraglutide）进行血糖干预，观察此类药物的降糖及心血管保护作用。……