急诊PCI术中小剂量替奈普酶+替罗非班IRA靶向给药对高血栓负荷STEMI临床疗效

    Efficacy of IRA targeted administration of low-dose tenecteplase combined with tirofiban in high thrombotic burden STEMI patients undergoing emergency PCI

      摘要
    • 摘要:
      目的 探讨急诊经皮冠状动脉介入（PCI）术中小剂量替奈普酶+替罗非班梗死相关动脉（IRA）靶向给药对高血栓负荷急性ST段抬高型心肌梗死（STEMI）临床疗效。
      方法 选取2023年4月～2024年2月120例在我院行急诊PCI的急性STEMI患者，按随机数字表法将其分为对照组替奈普酶（TNK-tPA）组，n=60和观察组（TNK-tPA+替罗非班组，n=60），观察两组患者术后即刻TIMI血流分级、TIMI心肌灌注分级（TMPG）、心肌坏死指标的血清肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）、乳酸脱氢酶（LDH）浓度、心肌再灌注损伤指标的血清内皮素1（ET-1）、高敏C反应蛋白（hs-CRP）及肿瘤坏死因子α（TNF-α）浓度、反应早期心功能变化的血浆N-末端脑钠肽前体（NT-proBNP）浓度和左心室射血分数（LVEF）。
      结果 与对照组比较，观察组术后即刻TIMI血流分级中3级占比明显高于对照组（P<0.05），PCI术后即刻TMPG3级占比明显高于对照组（P<0.05）；PCI术后可见观察组的CK（P<0.01）、CK-MB（P<0.05），LDH（P<0.05）、TNF-α（P<0.01）、ET-1（P<0.01）和hs-CRP（P<0.01）峰值浓度低于对照组。两组患者术后24 h血浆NT-prBNP浓度和LVEF值比较差异无统计学意义，术后1个月后进行随访，观察组LVEF值高于对照组（P<0.01），也高于同组术后24 h（P<0.01）；观察组血浆NT-proBNP浓度低于对照组(P<0.01)，也低于同组术后24 h（P<0.01）；两组出血发生情况比较，观察组和对照组出血例数分别为3例（5.00%）和4例（6.67%），两组比较差异无统计学意义。
      结论 PCI术中小剂量TNK-tPA联合替罗非班IRA靶向给药可及时恢复STEMI患者血流量，增加血液灌注，减少心肌损伤，有利于心功能恢复，具有较好的临床效果。

       

      Abstract:
      AIM  To evaluate the clinical efficacy of infarct-related artery (IRA) targeted administration of low-dose tenecteplase (TNK-tPA) combined with tirofiban during emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) and high thrombotic burden.
      METHODS  A total of 120 acute STEMI patients undergoing emergency PCI between April 2023 and February 2024 were randomly divided into two groups: a control group (60 cases, TNK-tPA alone) and an observation group (60 cases, TNK-tPA + tirofiban). Postoperative outcomes, including TIMI flow grade, TIMI myocardial perfusion grade (TMPG), myocardial necrosis markers serum creatine kinase (CK), creatine kinase isoenzyme (CK-MB), lactate dehydrogenase (LDH), myocardial reperfusion injury markers serum endothelin (ET), high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), and early cardiac function indicators plasma N-terminal pro-brain natriuretic peptide (NT-proBNP) and left ventricular ejection fraction (LVEF), were compared between the two groups.
      RESULTS  Compared with the control group, the observation group had a significantly higher proportion of grade 3 in TIMI blood flow grading immediately after surgery (P<0.05), and a significantly higher proportion of grade 3 in TMPG immediately after PCI compared to the control group (P<0.05); After PCI, the peak concentrations of CK (P<0.01), CK-MB (P<0.05), LDH (P<0.05), TNF-α (P<0.01), ET-1 (P<0.01), and hs CRP (P<0.01) in the observation group were lower than those in the control group. There was no statistically significant difference in plasma NT proBNP concentration and LVEF values between the two groups of patients 24 hours after surgery. Follow up was conducted one month after surgery, and the LVEF values in the observation group were higher than those in the control group (P<0.01) and also higher than those in the same group 24 hours after surgery (P<0.01); The concentration of NT proBNP was lower than that of the control group (P<0.01) and also lower than that of the same group at 24 hours after surgery (P<0.01); The comparison of bleeding incidence between the two groups showed that there were 3 cases (5.00%) of bleeding in the observation group and 4 cases (6.67%) in the control group, with no statistically significant difference between the two groups.
      CONCLUSION  IRA targeted administration of low-dose TNK-tPA combined with tirofiban during emergency PCI effectively restores coronary blood flow, improves myocardial perfusion, reduces myocardial injury, and promotes cardiac functional recovery in high thrombotic burden STEMI patients, demonstrating favorable clinical outcomes without increasing bleeding risk.

       

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