石林惠 董绉绉 叶龙强 刘盼盼

[摘要] 目的 探討乌司他丁对急性心肌梗死（AMI）患者溶栓后血清炎症介质表达水平的影响。 方法 选取2017年1～12月我院收治的AMI患者84例，随机分为对照组和试验组，每组各42例。对照组患者接受重组链激酶静脉溶栓治疗，试验组在溶栓治疗基础上，再给予乌司他丁静脉滴注。两组患者分别于治疗前、治疗后24 h及72 h抽取静脉血测定炎症介质hs-CRP、IL-1、IL-10及TNF-α的表达水平。 结果 治疗后24 h两组患者hs-CRP、IL-1、IL-10及TNF-α表达水平均较治疗前升高，差异有统计学意义（P<0.05），但试验组增加幅度低于对照组（P<0.05）。治疗后72 h两组患者炎症介质水平均显著低于同组治疗前及治疗后24 h（P<0.05），且试验组的降低幅度优于对照组，差异具有统计学意义（P<0.05）。两组在溶栓后住院期间不良反应及不良心血管事件发生情况比较，差异均无统计学意义（P>0.05）。 结论 AMI患者溶栓治疗前后应用乌司他丁可有效抑制炎症介质表达水平，减轻心肌缺血再灌注损伤。

[关键词] 乌司他丁；急性心肌梗死；溶栓；炎症介质

[中图分类号] R542.22 [文献标识码] B [文章编号] 1673-9701（2018）15-0117-04

Effect of ulinastatin on the expression of serum inflammatory mediators in patients with acute myocardial infarction （AMI） after thrombolysis

SHI Linhui DONG Zhouzhou YE Longqiang LIU Panpan

ICU， Ningbo Medical Center Lihuili Eastern Hospital， Ningbo Medical Center of Taipei Medical University， Ningbo 315040， China

[Abstract] Objective To investigate the effect of ulinastatin on the expression of serum inflammatory mediators in patients with acute myocardial infarction（AMI） after thrombolysis. Methods 84 patients with AMI in our hospital from January 2017 to December 2017 were selected and randomly divided into the control group and the experimental group with 42 cases in each group. The control group received recombinant streptokinase intravenous thrombolytic therapy， while the experimental group was given intravenous infusion of ulinastatin in the foundation of thrombolytic therapy. Two groups of patients were extracted venous blood to measure the expression levels of inflammatory mediators including hs-CRP， IL-1， IL-10 and TNF-α before treatment， 24 h and 72 h after treatment. Results 24 h after treatment， the expression levels of hs-CRP， IL-1， IL-10 and TNF-α in the two groups were higher than those before the treatment， and the difference was statistically significant（P<0.05）. However， the increase in the experimental group was lower than that of the control group （P<0.05）. 72 h after treatment， the levels of inflammatory mediators in the two groups were significantly lower than those before and 24 h after the treatment（P<0.05）. The decrease in the experimental group was higher than that of the control group and the difference between the two groups was statistically significant（P<0.05）. There was no significant difference in the incidence of adverse reactions and adverse cardiovascular events between the two groups during hospitalization after thrombolysis（P>0.05）. Conclusion The use of ulinastatin before and after thrombolytic therapy can effectively inhibit the expression levels of inflammatory mediators and relieve myocardial ischemia reperfusion injury in patients with AMI.

[Key words] Ulinastatin； Acute myocardial infarction； Thrombolysis； Inflammatory mediator

急性心肌梗死（acute myocardial infarction，AMI） 是严重威胁人类健康的疾病，其致死率接近30%[1]。静脉溶栓治疗是有效恢复缺血心肌再灌注、挽救患者生命的重要手段之一[2]，但冠脉血管再通后可诱发心肌缺血再灌注损伤（myocardial ischemia reperfusion injury，MIRI），导致并发各种心律失常，影响患者预后[3]。新近研究表明MIRI的病理生理过程涉及钙超载、氧自由基、NO合成失调及细胞凋亡等[4，5]，可引起包括hs-CRP、IL-1、IL-10及TNF-α等在内炎症介质的表达变化。乌司他丁作为一种广谱蛋白酶抑制剂，研究显示其可通过抑制体内多种蛋白酶活性、调节炎症介质释放及减少炎性浸润而具有改善MIRI的作用[6， 7]。本研究对进行溶栓治疗的AMI患者联合应用乌司他丁，通过观察不同时期血清hs-CRP、IL-1、IL-10及TNF-α的表达变化，评价乌司他丁在MIRI中的炎症抑制作用，旨在探讨乌司他丁對MIRI的保护机制。……