【摘要】 目的:观察经皮冠状动脉介入治疗(PCI)术中腺苷后适应对糖尿病急性心肌梗死(AMI)再灌注的保护作用。方法:将84例AMI患者按入选条件分为非糖尿病再灌注组(IR),非糖尿病腺苷后处理组(POST),糖尿病再灌注组(DIR),糖尿病腺苷后处理组(DPOST),糖尿病组按入院时所测糖化血红蛋白(HbA1c)值再分为DIR1(HbA1c<7%)、DIR2(HbA1c≥7%)、DPOST1(HbA1c<7%)、DPOST2(HbA1c≥7%)。POST及DPOST组于支架植入前静滴腺苷,IR及DIR组于支架植入前静滴等量生理盐水。检测PCI术前及术后30min冠脉血浆中的MDA、SOD及PCI术后6、12、24及48h静脉血CM-MB水平。结果:6组患者术后MDA值均较术前升高(P﹤0.01),SOD值均较术前降低(P﹤0.01);POST及DPOST组MDA值比IR及DIR组升高较少(P﹤0.05),SOD值比IR及DIR降低较少(P﹤0.05)。术后POST及DPOST组CK-MB峰值较IR及DIR组降低(P﹤0.05)。结论:糖尿病急性心肌梗死PCI治疗时应用腺苷后处理可以减轻心肌缺血再灌注损伤,起到心肌保护的作用。更多还原

【Abstract】 Objective To investigate the protective effect of adenosine postconditioning on ischemic-reperfused myocardium of acute myocardial infarction with diabetes during percutaneous coronary intervention(PCI) .Methods The 84 patients with acute myocardial infarction(AMI) were divided into 6 groups:non-diabetic ischemic-reperfused(IR) group,non-diabetic postconditioning(POST) group,diabetic ischemic-reperfused(DIR) group,diabetic postconditioning(DPOST) group.The diabetic groups were further divided into DIR1(HbA1c < 7%) ,DIR2(HbA1c ≥7%) ,DPOST1(HbA1c < 7%) ,DPOST2(HbA1c ≥7%) groups according to their HbA1c after admission.Adenosine was intravenously given in POST and DPOST groups before the stent was implanted.The same amount normal saline was given in IR and DIR groups.Coronary serum MDA and SOD were detected before PCI and 30 minutes later after PCI.Serum CK-MB was detected respectively 6 hours,12 hours,24 hours and 48 hours later after PCI.Results The level of MDA was significantly increased,but the level of SOD was significantly decreased in all the six groups after the operation(P < 0.01) .The level of MDA in POST group and DPOST groups is lower than that in IR group and DIR groups(P < 0.05) ,but the level of SOD is higher(P < 0.05) after PCI.The peak value of CK-MB of POST group and DPOST groups is significantly increased compared to IR group and DIR groups after PCI(P < 0.05) .Conclusion PCI combined with adenosine postconditioning treatments can alleviate ischemic-reperfused myocardial injury of patients with AMI and diabetes.更多还原