| Background Recanalize the infarct-related artery as soon as possible is the most important treatment principle for the patients with acute myocardial infarction with ST-segment elevation.However,with the restoration of coronary blood flow,tissue damage,reperfusion arrhythmia,myocardial infarction or even other serious phenomena will occur.Drug postconditioning as one of the way to reduce ischemia-reperfusion injury has gradually attracted our attention,because of its operability,relatively non-invasive advantages.Nitrate is non-endothelium-dependent exogenous nitric oxide(NO)donors,and it is the most widely used in anti-ischemic in clinical practice.It can dilate vascular smooth muscle,and inhibit platelet aggregation and blood vessels Smooth muscle proliferation,as well as inflammatory response and so on.Therefore,its application in the cardiovascular field is very broad in clinical practice,but its research for drug postconditioning is still in infancy.In recent years,basic experiments have shown that nitrate postconditioning can inhibit myocardial ischemia-reperfusion.However,nitrates postconditioning of clinical research is still rare.Whether nitrate postconditioning has a protective effect on myocardial ischemia-reperfusion injury for the acute myocardial infarction with ST-segment elevation patients is not clear,and whether it can reduce inflammation Reaction is also not clear.Objective To discuss the protective effect of nitrate on myocardial ischemia-reperfusion injury and whether it can protect myocardium by regulating inflammatory reaction.Methods Patients in Qingdao Hiser Medical Center and Qingdao Municipal Hospital with STsegment elevation acute myocardial infarction(AMI)according to the 2017 American Society of Cardiology(ACC)and the American Heart Association(AHA)guidelines whounderwent routine PCI from October 2017 to January 2018 were selected except that with significant anemia,head trauma and intracerebral hemorrhage.Significant hypotension(systolic blood pressure less than 90 mm Hg)and exclusion of patients with autoimmune system disease,severe infection and malignant tumor.The eligible patients were randomly divided into two groups: group A(routine control group): PCI standardized treatment.Group B(isosorbide postconditioning group): During PCI,after insertion of guide wire to open ischemic coronary artery,2 mg of isosorbide was immediately injected into the ischemic coronary artery.Venous blood of two groups was collected before PCI and after 2 hours,1 day,4 days and 7 days of PCI.Venous blood was centrifuged at 1000 rpm for 20 minutes at normal temperature,and the serum was isolated.Then stored it in-20 ? refrigerator.The concentrations of TNF-?,IL-17,CTn I in serum were detected by ELISA method in each group.The data was statistically analyzed with SPSS statistical software,and P < 0.05 was statistically significant.Results 1.Comparison of general clinical data of two groups There was no significant difference in sex,age,diabetes mellitus,hypertension,smoking history and dyslipidemia of two groups.2.Comparison of serum CTn I of two groups The CTn I concentration in control group was(10.72±33.63)ng/ml,and(12.33±22.25)ng/ml in experimental group,P > 0.05,indicating that the data of two groups were not statistically different before operation,so the data of two groups were comparable at different time after operation.The concentration of CTn I of two groups in the time of 2h and 1d after the operation was no statistical difference,despite that experimental groups was lower than that in the control group,but the P was > 0.05.The concentration of CTn I in the experimental group in 4d and 7d was(3.88±4.71)ng/ml and(0.35±1.43)ng/ml respectively,which was lower than that in the control group(10.64±9.72)ng/ml,(1.52±2.87)ng/ml,and P < 0.05,indicating that the difference was statistically significant.In the control group,c Tn I reached the peak at 1d after operation,and the peak reached 2h in the experimental group.3.Comparison of serum TNF-? of two groups The concentrations of TNF-? in control group before operation were(0.145±0.032)pg/ml,and(0.142±0.030)pg/ml in experimental group,P > 0.05,indicating that there was no statistical difference between the two groups before operation,so the two groups were comparable at different time points after operation.After the operation,the concentration of TNF-? of experimental group in the 2h was lower than that in the control group,but P > 0.05,so there was no statistical difference between the two groups.The concentrations of TNF-? of the experimental group in 1d,4d,7d were(0.154±0.023)pg/ml,(0.136±0.021)pg/ml,(0.127±0.023)pg/ml respectively,compared with the control group(0.154±0.023)pg/ml,(0.136±0.021)pg/ml(0.127±0.023)pg/ml,and P < 0.05,the difference was statistically significant.The peak height of TNF-? at 1d after operation in the two groups.4.Comparison of serum IL-17 of two groups The concentrations of IL-17 in control group before operation were(0.254 + 0.070)pg/ml,and(0.239 + 0.039)pg/ml in experimental group,P > 0.05,indicating that there were not statistically different before operation,so the data of two groups were comparable at different time after operation.After the operation,the concentration of IL-17 of experimental groups in the 2h and 1d was lower than that in the control group,but the P was > 0.05,so there was no statistical difference between the two groups.The concentration of IL-17 in 4d and 7d in the experimental group was(0.263 + 0.037)pg/ml and(0.269 + 0.036)pg/ml respectively,compared with the control group(0.286 + 0.031)Pg/ml,(0.315 + 0.078)pg/ml,and P < 0.05,indicating that the difference was statistically significant.The peak height of IL-17 at 7d after operation in the two groups.Conclusion 1.It is confirmed that the postconditioning of nitrates with 2mg in patients with STsegment elevation acute myocardial infarction during PCI treatment has a protective effect on myocardial ischemia reperfusion injury.2.The treatment of nitrate postconditioning may protect the myocardium by reducing the mechanism of the inflammatory reaction. |
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