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目的探讨螺内酯预处理对经皮冠状动脉介入治疗(PCI)围手术期的心肌保护作用。方法将如皋市人民医院心内科2007年6月至2010年12月择期PCI的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(20～40 mg/d)进行预处理,而对照组给予安慰剂。分别测定并比较2组PCI术前、术后主动脉根部平均动脉压力(MAPA)、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。所有数据采用SPSS 11.5软件包进行数据分析。结果 A、B两组患者在年龄、性别、手术时间、球囊扩张次数、支架植入数量等方面差异无统计学意义;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,A组cTn-I、CRP、BNP浓度均低于B组(P<0.05),而MAPA高于B组(P<0.05);相关分析表明ΔMAPA(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、减轻心衰,其机制可能与螺内酯预处理可以增加心肌灌注有关。
Objective To investigate the protective effects of spironolactone preconditioning on perioperative myocardial perfusion during percutaneous coronary intervention (PCI). Methods Patients in the PCI group from June 2007 to December 2010 in Rugao People’s Hospital were randomly divided into treatment group (group A, n = 116) and control group (group B, n = 121). The treatment group received spironolactone Oral (20-40 mg / d) pretreatment, while the control group was given placebo. The mean arterial pressure (MAPA), Aldo, cTn-I, BNP, C-reactive protein (CRP) concentration changes. All data were analyzed using SPSS 11.5 software package. Results There was no significant difference in age, sex, operation time, number of balloon dilatation and the number of stent implantation in group A and group B. The intraoperative comparison of postoperative Aldo, cTn-I, BNP and CRP The levels of cTn-I, CRP and BNP in group A were significantly lower than those in group B (P <0.05), but MAPA was higher in group A than in group B (P < 0.05). Correlation analysis showed that ΔMAPA was negatively correlated with ΔcTn-I (postoperative / preoperative), ΔCRP (postoperative / preoperative) and ΔBNP (postoperative / preoperative), respectively -0.69, -0.51, -0.56 (P <0.05 or P <0.01). Conclusion Spironolactone preconditioning can reduce perioperative myocardial damage associated with perioperative PCI, inhibit the inflammatory response and relieve heart failure. The mechanism may be related to the pretreatment of spironolactone to increase myocardial perfusion.