摘要
目的探讨曲美他嗪联合依折麦布通过调控miRNA对不稳定心绞痛患者PCI术后临床疗效。方法前瞻性选取2019年1月至2020年6月协和江北医院收治的92例行PCI术的不稳定心绞痛患者,随机数字表法分为普通组(n=46)和实验组(n=46)。普通组给予常规抗凝、抗血小板、β受体阻滞剂、他汀类、以及钙离子拮抗剂等药物治疗,实验组术前1周开始加用曲美他嗪和依折麦布口服,并服用至术后1年。比较两组患者术前和术后16~18 h肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、肌红蛋白(Myo)、微小RNA-21(miRNA-21)、和微小RNA-222(miRNA-222)的水平,对比两组患者治疗的有效性,分析miRNA-21和miRNA-222与心肌梗死标志物的相关性,以及预测治疗有效性的受试者工作特征(ROC)曲线分析,随访两组患者12个月的心脑血管不良事件(MACCEs)以及药物的不良反应。结果PCI术前,两组患者的cTnI、肌酸激酶同工酶CK-MB、Myo、miRNA-21、miRNA-222比较,差异均无统计学意义(P>0.05);术后16~18 h,实验组的cTnI、CK-MB、Myo和miR-222分别为(2.10±0.33)μg/L、(60.16±14.32)μg/L、(207.86±33.08)μg/L、0.65±0.11,明显低于对照组[(2.33±0.54)μg/L、(67.25±12.14)μg/L、(220.74±23.81)μg/L、0.71±0.14],miRNA-21为3.88±0.63,明显高于对照组(3.25±0.62),差异均有统计学意义(P<0.05)。miRNA-21水平与cTnI、Myo呈明显正相关(r=0.488、0.247,P<0.05),与CK-MB无明显相关性;miRNA-222水平与cTnI、CK-MB、Myo呈明显正相关(r=0.690、0.290、0.252,P<0.05)。实验组治疗明显有效的患者比率为56.52%,显著大于对照组(30.43%),差异有统计学意义(P<0.05);两组治疗有效率比较,差异无统计学意义(P>0.05)。实验组MACEs发生率为6.52%,显著低于对照组(23.91%),差异有统计学意义(P<0.05)。两组药物不良反应发生率未见明显差异(P>0.05)。结论曲美他嗪联合依折麦布能上调miRNA-21,下调miRNA-222,降低心肌梗死标志物的水平,减少12个月内MACCEs的发生且不增加药物不良反应发生率。
Objective To investigate the protective effect of trimetazidine combined with ezetimib on myocardial ischemia-reperfusion injury by regulating miRNA.Methods A total of 92 patients with PCI admitted to Union JiangBei Hospital from January 2019 to June 2020 were randomly divided into two groups:normal group(n=46)and experimental group(n=46).Routine anticoagulation,antiplatelet,β-blocker,statins,calcium antagonists and other drugs were given to the common group.Trimetazidine and ezetimib was added to the experimental group one week before the operation and and were taken until one year after operation.CTnI,CK-MB,Myo,miRNA-21,miRNA-222 were compared between the two groups before the operation,16~18 hours after the operation.MACEs within one year were also compared.The treatment effectiveness of the two groups was compared,the correlation between miRNA-21 and miRNA-222 and myocardial infarction markers was analyzed,the receiver operating characteristic(ROC)curve of miRNA was drawed to predict the treatment effectiveness,and Cardiovascular and cerebrovascular adverse events(MACCEs)and adverse drug reactions were followed up for 12 months in the two groups.Results There was no significant difference in cTnI,CK-MB,Myo,and miRNA-21 between the two groups before PCI(P>0.05).16-18 h after operation,the cTnI,CK-MB,Myo and miR-222 in the experimental group were(2.10±0.33)μg/L,(60.16±14.32)μg/L,(207.86±33.08)μg/L,0.65±0.11,which were significantly lower than those in the control group[(2.33±0.54)μg/L,(67.25±12.14)μg/L,(220.74±23.81)μg/L,0.71±0.14],miRNA-21 was 3.88±0.63,which was significantly higher than that in the control group(3.25±0.62),and the differences waere statistically significant(P<0.05).The level of miRNA-21 was positively correlated with cTnI and Myo(r=0.488,0.247,P<0.05),but not with CK-MB;the level of miRNA-222 was positively correlated with cTnI,CK-MB and Myo(r=0.690,0.290,0.252,P<0.05).The proportion of patients in the experimental group with obvious effective treatment was 56.52%,which was significantly higher than that in the control group(30.43%),and the difference was statistically significant(P<0.05).There was no significant difference in the treatment effective rate between the two groups(P>0.05).The incidence of MACEs in the experimental group was 6.52%,which was significantly lower than that in the control group(23.91%),and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of drug side effects between the two groups(P>0.05).Conclusion Trimetazidine combined with ezetimib can up regulate miRNA-21 and down regulate miRNA-222,reduce the level of myocardial infarction markers and the incidence of macces within 12 months,and do not increase the incidence of drug side effects.
作者
石庆元
黄菲菲
柳梅
SHI Qing-yuan;HUANG Fei-fei;LIU Mei(Department of Cardiovascular Medicine,Union Jiangbei Hospital,Wuhan Hubei 430010,China;Department of Intensive Care Unit,Wuhan Integrated Traditional Chinese and Western Medicine Hospital,Wuhan Hubei 430000,China)
出处
《临床和实验医学杂志》
2022年第14期1481-1485,共5页
Journal of Clinical and Experimental Medicine
基金
湖北省科技计划项目(编号:2018CFB354)。
