| Objective:To observe the intervention effect and mechanism of SYD on myocardial injury(PMI)in patients with non st-elevation acute coronary syndromes(NSTE-ACS).Method:This subject adopts,randomized,double blind,placebo controlled observation method,the object of study are affiliated to the capital university of medical sciences,Beijing Chinese medicine hospital cardiovascular division in July 2016 to December 2016 success of coronary artery intervention(PCI)therapy,TCM syndrome type belong to qi deficiency and blood stasis syndrome of patients with nste-acs.Ultimately 68 patients were randomized into standard SYD group(n = 36)and placebo(n = 32),all of the patients undergoing coronary artery disease on the basis of routine therapy in the preoperative taken according to the grouping of three days of SYD or placebo,then according to the specific patient undergoing elective PCI therapy.Clinical observation includes:(1)preoperative and postoperative 4 h,24 h after surgery and postoperative EPCs count 7d peripheral blood;Promote vascular endothelial generated factor VEGF level changes,the SDF-1;Myocardial injury markers cTNT,the change of CK-MB;Oxidative stress indicators:the change of SOD,MDA,Inflammation index hs-the change of CRP,IL-6.(2)the preoperative and postoperative 24 h lines of color doppler ultrasound and using velocity vector imaging(VVI);(3)after 34 days MACE events(for all-cause death,again hair,myocardial infarction,angina pectoris,coronary revascularization,nonfatal stroke)and slight hemorrhage,little bleeding,bleeding,bleeding events)(4)security monitoring.Result:(1)Baseline conditions:SYD group and placebo group in all patients with baseline data were no statistical difference(P>0.05),comparable.(2)the incidence of the PMI:SYD group,the incidence of PMI(2.8%)was significantly lower than that in placebo group(21.9%),the difference between the two groups was statistically significant(P<0.05).(3)the level of CK-MB detection:compared with PCI preoperatively,the CK-MB level of postoperative 4h,24 h in SYD group and postoperative 4h,24 h,7d in the placebo group was significantly higher,the difference was statistically significant.Compared with the postoperative 7d(P>0.05),the difference was not statistically significant.The CK-MB level of postoperative 4h,24h and 7d in SYD group were lower than those in the placebo group,but the difference was not statistically significant(P>0.05).(4)EPCs mobilization:?the EPCs count:compared with PCI preoperatively,the peripheral blood EPCs levels of postoperative 24h,7d in SYD group were higher(P<0.05),the difference is statistically significant.compared with postoperative 4h in SYD group,postoperative 4h,24h and 7d in placebo group(P>0.05),the difference was not statistically significant.Compared with placebo group,postoperative 24h,7d in SYD group were higher than those in placebo group at the same time point(P<0.05),the difference was statistically significant.Compared with the two groups,postoperative 4h in SYD group was higher than that in the placebo group(P>0.05),but the difference was not statistically significant.? VEGF level:compared with PCI preoperative,the VEGF level of postoperative 24h,7d in SYD group and postoperative 24h in the placebo group were higher(P<0.05),the difference is statistically significant.compared with postoperative 4h in SYD group and postoperative 4h,7d in the placebo group(P>0.05),the difference was not statistically significant.postoperative 24h,7d in SYD group were higher than that of the placebo group at the same time point(P>0.05),the two groups of postoperative 4h(P>0.05),the difference both were not statistically significant.?SDF-1 level:compared with PCI preoperative,the SDF-1 level of postoperative 24h in SYD group was higher(P<0.05),the difference is statistically significant.compared with postoperative 4h,7d in SYD group and postoperative 4h,24h,7d in the placebo group(P>0.05),the difference was not statistically significant.postoperative 24h.7d in SYD group were significantly higher than that of the placebo group at the same time point(P<0.05),the difference was statistically significant.and there was no significant difference in postoperative 4h between the two groups(P>0.05).the difference was not statistically significant.? SYD group of PCI preoperative,PCI postoperative 4 h,24 h,7 d peripheral blood EPCs and VEGF levels exist significant correlation(r = 0.231,P<0.05);SYD group of PCI preoperative,PCI postoperative 4 h,24 h,EPCs and SDF-1 level 7 d peripheral blood exist significant correlation(r = 0.323,P<0.05).(5)inflammation factors:?the Hs-CRP levels:compared with PCI preoperative,the Hs ?CRP level of postoperative 24h in SYD group and placebo group were higher(P<0.05),the difference is statistically significant.compared with postoperative 4h,7d in SYD group and placebo group(P>0.05),the difference was not statistically significant.postoperative 4h,24h,7d in SYD group were lower than that of the placebo group at the same time point(P>0.05),but the difference was not statistically significant.?the level of IL-6:compared with PCI preoperative,the IL-6 level of postoperative 24h in SYD group and postoperative 4h,24h in placebo group were higher(P<0.05),the difference is statistically significant.compared with postoperative 4h,7d in SYD group and postoperative 7d in placebo group(P>0.05),the difference was not statistically significant.postoperative 4h,24h,7d in SYD group were lower than that of the placebo group at the same time point(P>0.05),but the difference was not statistically significant.(6)oxidative stress:?the SOD level:compared with PCI preoperative,the SOD level of postoperative 24h in placebo group were lower(P<0.05),the difference is statistically significant.compared with postoperative 4h,24h,7d in SYD group and postoperative 4h,7d in placebo group(P>0.05),the difference was not statistically significant.postoperative 24h in SYD group was significantly higher than that of the placebo group at the same time point(P<0.05),the difference was statistically significant-postoperative 4h,7d in SYD group were higher than that of the placebo group at the same time point(P>0.05),but the difference was not statistically significant.?the MDA level:compared with PCI preoperative,the MDA level of postoperative 24h in placebo group and placebo group were higher(P<0.05),the difference is statistically significant.compared with postoperative 4h,7d in SYD group and placebo group(P>0.05),the difference was not statistically significant.postoperative 4h,24h,7d in SYD group were lower than that of the placebo group at the same time point(P>0.05),but the difference was not statistically significant.(7)ultrasonic echocardiography and VVI technology:? and SYD group of PCI postoperative 24 hours left ventricular ejection fraction,left ventricular end-diastolic diameter and E/A value comparison preoperative did not occur with the dynamic change of statistical significance(P>0.05).? In the placebo group,the strain of the anterior septal,apical,anterior,apical,anterior,basal,lower,and lower walls of 24h after PCI was lower than the preoperative level(P<0.05),and the difference was statistically significant;PCI postoperative 24 hours and SYD group compared with placebo,apex long before the first interval apex,wall and lower wall apex section to improvement and SYD group is better than that of the placebo group(P<0.05),the difference is statistically significant ? In the placebo group,the strain rate index of the anterior septal,apical,anterior,apical,lower,and lower segments of 24h after PCI was lower than the preoperative level(P<0.05),and the difference was statistically significant;PCI postoperative 24 hours and SYD group compared with placebo,apex long before the first interval apex,wall and lower wall apex section to improvement and SYD group is better than that of the placebo group(P<0.05),the difference is statistically significant.(8)MACE events and safety detection:comparison between the two groups,two groups of postoperative incidence of 30-day MACE events not statistically difference(5.6%VS 15.6%,P = 0.335);Two groups of postoperative bleeding eents 30 days(0%VS 6.25%);Did not see SYD related adverse reactions occur,security is good.Conclusion:(1)SYD can decrease the incidence of patients with NSTE-ACS PMI,lower levels of serum CK-MB,reduce the occurrence of postoperative 30-day MACE,bleeding events,and good safety,prompt SYD PCI in patients with NSTE-ACS perioperative myocardial protection.(2)SYD can increase peripheral blood levels of EPCs,level of VEGF and SDF-1 level,prompt SYD can promote NSTE-ACS patients undergoing elective PCI perioperative EPCs mobilization and homing,its mechanism may be related to increase the expression of VEGF in the peripheral blood and SDF-1,to activate the bone marrow in PI-3 k/Akt signaling pathways,activate the Akt and eNOS.It could be improve PCI in patients with NSTE-ACS one of perioperative myocardial injury mechanism.(3)SYD can reduce NSTE-ACS patients undergoing elective PCI perioperative Hs-CRP serum inflammation factors and the levels of IL-6,prompt SYD play of NSTE-ACS patients undergoing elective PCI perioperative myocardial protection mechanism may be associated with inhibiting the inflammatory response.(4)SYD intervention NSTE-ACS patients undergoing elective PCI perioperative,inhibits PCI postoperative SOD decreased,inhibition of PCI postoperative MDA rise,prompt SYD of NSTE-ACS patients undergoing elective PCI perioperative myocardial protection mechanism may be associated with resistance to oxidative stress effect.(5)VVI technique is used to analyze the section room wall systolic function changes,for segmental myocardial strain and strain rate effect index,find the cords SYD regional ventricular wall motion to compare the placebo group has improved,also prompt VVI more help than traditional ultrasonic echocardiography PMI early detection.To sum up:SYD of NSTE-ACS patients undergoing elective PCI perioperative myocardial protection,has certain EPCs mobilization and its mechanism may be related to promote homing,inhibit inflammation and oxidative stress resistance related. |
PDF Full Text Request