替罗非班对急性冠脉综合征患者血管内皮功能障碍的影响

目的 研究替罗非班（欣维宁注射液）对急性冠脉综合征（acute coronary syndrome,ACS）患者血管内皮功能障碍的影响.方法 连续入选86例ACS患者,随机分为2组：替罗非班组40例,对照组46例.除常规药物治疗外,替罗非班组予替罗非班注射液10 μg/（kg·min）负荷剂量,静脉推注3 min,而后以0.15 μg/（kg·min）匀速持续静脉泵入48～72 h;对照组予生理盐水静脉泵入.入院后即刻抽血测内皮素（ET）、一氧化氮（NO）.用药24 h后,抽血复查上述指标,并用高频超声探头分别测量两组患者肱动脉基础内径、反应性充血内径、含服硝酸甘油后内径,计算血流介导的动脉血管舒张功能（flow-mediated dilation,FMD）和硝酸甘油介导的血管舒张功能（nitroglycerin-mediated dilation,NMD）.最后比较两组间及组内上述参数的差异.结果 用药后替罗非班组与对照组比较,其FMD明显好于对照组,差异有统计学意义（6.2%±3.0% vs 4.6%±2.1%,P=0.008）,然而两组在NMD方面差异无统计学意义.同时替罗非班组NO水平显著升高（38.63±16.42） μmol/L vs （44.74±2.77） μmol/L,P=0.017],ET水平显著降低（117.61±14.25） pg/ml vs（107.57±16.45）pg/ml,P=0.006].结论 应用替罗非班可以改善急性冠脉综合征患者的FMD,显著升高NO水平,降低ET水平,提示替罗非班对血管内皮细胞有明显的保护作用,可改善血管内皮功能障碍.

Effect of tirofiban on vascular endothelial dysfunction in patients with acute coronary syndrome

Objective To study the effect of tirofiban on endothelial dysfunction in patients with acute coronary syndrome. Methods Eighty - six consecutive patients diagnosed as having acute coronary syndrome were recruited. They were randomly divided into two groups： tirofiban group （n = 40） and control group （n = 46）. Tirofiban was administered with a loading dose of 10 μg/（ kg · min） for 3 minutes, followed by infusion of 0.15 μg/（ kg ·min） for 48 -72 hours. And the patients in control group were given physi- ological saline. The blood samples of the patients were obtained immediately after enrollment. The serum levels of ET and NO were measured. After 24 hours, the above - mentioned tests were repeated and the baseline diameter of brachial artery, the reactive hypere- mia diameter and the diameter after sublingual nitroglycerin were examined respectively by high - resolution ultrasonic transducer. The FMD and NMD were calculated. The parameters were respectively compared in two groups and between groups. Results Compared with control group, the FMD was obviously better in tirofiban group （6.2% ±3.0% vs 4.6% ±2.1%, P =0. 008）. But no signifi- cant difference of FMD was observed between the two groups. And tirofiban significantly increased the level of NO （38.63 ± 16.42） p, mol/L vs （ 44.74 ± 2.77 ） μmol/L, P = 0.017 ] and decreased the level of ET （ 117.61 ± 14.25 ） pg/ml vs （ 107.57± 16.45 ） pg/ ml, P = 0.0061 - Conclusions For the patients of ACS, the therapy of tirofiban can improve the FMD, and significantly decrease the levels of ET and increase the density of NO, indicating that tirofiban can protect the vascular endothelial cells and improve the vascular endothelium dysfunction.