2021 年第 1 期 第 16 卷

小檗碱对急性心肌梗死经皮冠状动脉介入术后冠状动脉不稳定斑块的治疗作用

Therapeutic effect of berberine on coronary arteries unstable plaques in acute myocardial infarction after percutaneous coronary intervertion

作者：梁万添唐良秋陈锦峰庞军刚周婉明陈伟强陈姣

英文作者：Liang Wantian Tang Liangqiu Chen Jinfeng Pang Jungang Zhou Wanming Chen Weiqiang Chen Jiao

单位：汕头大学医学院附属粤北人民医院心血管内科，广东省韶关市512000

英文单位：Department of Cardiology Yue Bei People′s Hospital Shantou University Medical College Guangdong Province Shaoguan 512000 China

关键词：急性心肌梗死；小檗碱；不稳定斑块'>陈锦峰庞军刚周婉明陈伟强陈姣

英文关键词：Acutemyocardialinfarction;Berberine;Unstableplaque 

• 摘要：

• 目的 探讨小檗碱对急性心肌梗死经皮冠状动脉介入（PCI）术后冠状动脉不稳定斑块的治疗作用。方法纳入2017年8月至2019年2月汕头大学医学院附属粤北人民医院心血管内科收治的行PCI治疗的急性心肌梗死患者150例，按照随机数字表法分为常规组和小檗碱组，各75例。常规组在PCI术后给予抗凝、稳定斑块、抗血小板等治疗；小檗碱组在常规组基础上辅以小檗碱口服治疗。观察2组患者治疗前后血脂水平、脂蛋白相关磷脂酶A2(Lp-PLA2)及高敏C反应蛋白(hs-CRP)水平。随访1年，比较2组患者急性冠状动脉综合征（ACS）发生风险；1年后复查冠状动脉造影，观察2组患者发生不稳定斑块数量情况；记录2组患者治疗期间不良反应发生情况。结果 治疗后小檗碱组总胆固醇、三酰甘油、LDL-C水平低于常规组，差异均有统计学意义（均P＜0.05）。治疗后小檗碱组Lp-PLA2、hs-CRP水平低于常规组，差异均有统计学意义（均P＜0.05）。Kaplan-Meier生存曲线分析结果显示，小檗碱组再发ACS风险低于常规组（Log-rank χ2=4.569，P=0.033）。冠状动脉造影显示，小檗碱组冠状动脉不稳定斑块数量低于常规组［（2.1±0.5）个比（3.2±0.5）个］，差异有统计学意义（P＜0.05）。2组患者治疗期间不良反应发生率比较差异无统计学意义（P=0.754）。结论 急性心肌梗死患者PCI术后给予小檗碱能够有效调节血脂、稳定斑块、减轻内皮下炎症反应，降低ACS再发风险，且安全可靠。

• Objective To investigate the therapeutic effect of berberine on coronary arteries unstable plaques after percutaneous coronary intervention (PCI) in acute myocardial infarction. Methods From August 2017 to February 2019，150 patients with acute myocardial infarction  treated with  PCI  in Department of Cardiology, Yue Bei People′s Hospital, Shantou University Medical College were enrolled. They were randomly divided into routine group and berberine group, with 75 cases in each group. The routine group was treated with anticoagulation, plaque stabilization, and antiplatelet after PCI. The berberine group was treated with oral berberine on the basis of the routine group. The levels of blood lipid, lipoprotein-related phospholipase A2 (Lp-PLA2) and high sensitivity C-reactive protein (hs-CRP) were compared between the two groups before and after treatment. Followed-up for 1 year, the risk of acute coronary syndrome (ACS) were compared between the 2 groups; rechecked coronary angiography 1 year later, the number of unstable plaques were observed in the 2 groups; the occurrence of adverse reactions were recorded during the treatment in the 2 groups. Results The levels of total cholesterol, triglyceride and low-density lipoprotein-C in the berberine group were lower than those in the routine group after treatment, and the differences were statistically significant (all P＜0.05). After treatment, the levels of Lp-PLA2 and hs-CRP in the berberine group were lower than those in the routine group (both P＜0.05). Kaplan-Meier survival curve showed that the risk of ACS recurrence in the berberine group was lower than that in the routine group (Log-rank χ2=4.569, P=0.033). Coronary angiography showed that the number of coronary arteries unstable plaques of the berberine group was lower than that of the conventional group［（2.1±0.5） vs （3.2±0.5）］(P＜0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups during treatment (P=0.754). Conclusion The application of berberine after PCI in patients with acute myocardial infarction can effectively regulate blood lipids, stabilize plaque, reduce subendothelial inflammation, reduce the risk of recurrence of ACS, and is safe and reliable.