The Research Of The Intervention And Mechanism Of Ligustrazine Post-processing On Myocardial Reperfusion In Patients With ACS

ObjectiveThis experiment was designed to observate the effects of ligustrazine post-processing on myocardial reperfusion injury in the patients with ACS which accept interventional therapy and explore the protections to the survival myocardium and its mechanism and give clinical datas to support the mechanism mentioned above. At the same time, this test can provide reliable basis of the curative effect and security of ligustrazine post-processing scheme for ACS patients.MethodsWe will Select60cases in patients who Conform to the ACS diagnosis and will undergoing PCI therapy, then divide them randomly into control group （30cases） and the experimental group （30cases）. After the blood flow restore by balloon expansion, the control group patients would be given injection in coronary artery with200μnitroglycerin+20ml （lmg）tirofiban within5minutes, and with the treatment of tirofiban4ml/h （0.2mg/h）for24hours after operation. The experimental group patients will be given10ml （20mg） Ligustrazine injection in the coronary artery and80mg Ligustrazine injection once a day for7days besides the same treatment of the control group. The data of this two groups which would be observed and marked down are corrected TIMI frame count （CTFC）of infarct related artery, myocardial Blush grade and the results of serum phospholipase A2（LP-PLA₂）, high sensitivity C-Reactive Protein（hs-CRP）, platelet aggregation function, serum creatine phosphokinase （CK） and creatine phosphokinase isoenzyme （CK-MB） both peak and peak time, and the TCM syndrome scoring curative effect. Through the statistical analysis of the effect of ligustrazine post-processing of reperfusion myocardial and its significance on clinical, we could obtain the result of difference between this two gropes and evaluatie the TCM effect on it.ResultsWith1fall off case of experimental group,29patients in the test group and30patients in the control group will be had a comparation among clinical efficacy and safety, here are the result:1. There is no statistical difference （P>0.05） between this two groups in gender, age, vital signs on admission, history of smoking, drinking, history of hypertension, diabetes, infarct related vascular distribution.2. There is no statistical difference between this two groups in corrected TIMI frame count （P=0.748）, myocardial Blush grade （P=0.347）, the peak CK, CK, CK-MB peak, peak time CK-MB peak time （all P>0.05）.3. PAG%presents no statistical difference between the two groups before treatment （P=0.515）, and test group （28.28±10.29） is lower than the control group （36.31±13.54） after treatment （P=0.013）.4. The LP-PLA₂of two groups before treatment has no statistical difference （P=0.389）, test group after treatment （154.93±16.31） is lower than the control group （247.73±18.59）（P=0.048）.5. The scores of US-CRP of two groups has no statistical difference （P=0.814, P=0.048） before and after treatment. The ratio US-CRP between the before and the after treatment （2.09±2.02） of the test group is higher than the control group （1.12±1.45）, prompted that a greater reduction（P=0.039）.6. There is no statistical difference between the two groups in left ventricular ejection fraction （P=0.581）, blood lipid test （TC, TG, HDL-C, LDL-C and its ratio before and after treatment, all P>0.05）.7. Syndromes curative effect analysis show that there is no statistical significance （P=0.855） between two groups on admission. But the treatment group get a lower score than the control group after treatment, and the result is statistically significant （P=0.047）.The total effective rate of the test group （93.1%） is higher than the control group （73.3%）, statistical significance （P=0.043）.8. In terms of major cardiovascular events MACE, the data of two groups have no statistical difference （P=0.708）.The liver and the kidney function checking results before and after admission to hospital and bleeding events count between the two groups have no statistical difference （P>0.05）.Conclusion:For ACS patients, adding the post-treatment of ligustrazine can improve myocardial microcirculation, reducing myocardial reperfusion injury, and the clinical use of this scheme is safe and reliable without founding any increased risk of bleeding and other risk of cardiovascular events through this test. The mechanism of such result consider to be:Reduce the myocardial cell calcium overload, anti inflammation, anti-platelet aggregation and the ischemic postconditioning effect by intravascular pharmacy.