2022 年第 4 期 第 17 卷

左西孟旦对老年急性心肌梗死合并心力衰竭患者血清可溶性生长刺激表达基因2蛋白及髓过氧化物酶和基质金属蛋白酶9水平的影响

Effects of levosimendan on levels of serum soluble growth stimulation expressed gene 2 protein, myeloperoxidase and matrix metalloproteinase-9 in elderly patients with acute myocardial infarction complicated with heart failure

作者：付国强1张薇2黄谭1杨正轩1钱振1

英文作者：Fu Guoqiang1 Zhang Wei2 Huang Tan1 Yang Zhengxuan1 Qian Zhen1

单位：1空军军医大学第二附属医院急诊科，西安710038；2空军军医大学第二附属医院心内科，西安710038

英文单位：1Department of Emergency the Second Affiliated Hospital of Air Force Medical University Xi′an 710038 China; 2Department of Cardiology the Second Affiliated Hospital of Air Force Medical University Xi′an 710038 China

关键词：左西孟旦；可溶性生长刺激表达基因2蛋白；髓过氧化物酶；基质金属蛋白酶9

英文关键词：Levosimendan;Solublegrowthstimulatorgene2protein;Myeloperoxidase;Matrixmetalloproteinase-9

• 摘要：

• 目的 探究左西孟旦对老年急性心肌梗死（AMI）合并心力衰竭患者血清可溶性生长刺激表达基因2蛋白（sST2）、髓过氧化物酶（MPO）、基质金属蛋白酶9（MMP-9）水平的影响。方法 回顾性分析2020年3月至2021年3月于空军军医大学第二附属医院接受治疗的85例老年AMI合并心力衰竭患者的临床资料。根据不同药物治疗方法将其分为观察组（43例）和对照组（42例）。所有患者均接受急诊经皮冠状动脉介入治疗。对照组予阿司匹林肠溶片、硫酸氢氯吡格雷片、阿托伐他汀钙等常规基础治疗，观察组在对照组基础上联合左西孟旦微量泵静脉输注治疗。2组均治疗1周。比较2组临床疗效，治疗前后血清sST2、MPO、MMP-9、炎症因子水平、超声心动图指标及不良反应发生情况。结果 观察组总有效率高于对照组［97.7%（42/43）比71.4%（30/42）］，差异有统计学意义（P＜0.05）。治疗后，2组血清sST2、MPO、MMP-9、白细胞介素6、肿瘤坏死因子α、高敏C反应蛋白水平、左心室舒张末期内径、左心室收缩末期内径均较治疗前降低，且观察组均低于对照组［（81±6）μg/L比（93±7）μg/L、（456±21）μg/L比（499±22）μg/L、（63±7）μg/L比（83±8）μg/L、（20±3）ng/L比（26±4）ng/L、（15.1±2.0）ng/L比（20.3±2.0）ng/L、（16.8±1.9）mg/L比（27.2±2.7）mg/L、（51±3）mm比（57±3）mm、（40±4）mm比（45±4）mm］，左心室射血分数均较治疗前升高，且观察组高于对照组，差异均有统计学意义（均P＜0.001）。2组不良反应发生率比较差异无统计学意义（P＞0.05）。结论 左西孟旦可降低老年AMI合并心力衰竭患者血清sST2、MPO、MMP-9水平，抑制炎症反应，改善心功能，在短期治疗中具有较高的安全性与良好的临床效果。

• Objective To explore the effects of levosimendan on levels of serum soluble growth stimulator gene 2 protein (sST2), myeloperoxidase (MPO) and matrix metalloproteinase-9 (MMP-9) in elderly patients with acute myocardial infarction (AMI) complicated with heart failure. Methods From March 2020 to March 2021, clinical data of 85 elderly patients with AMI complicated with heart failure admitted to the Second Affiliated Hospital of Air Force Medical University were retrospectively analyzed. Patients were divided into observation group (43 cases) and control group (42 cases) according to the drug therapy. All patients were treated with emergency percutaneous coronary intervention. The control group was treated with aspirin enteric-coated tablets, clopidogrel bisulfate tablets, atorvastatin calcium and other basic treatment, and the observation group was treated with levosimendan micropump intravenous infusion based on the control group. Both groups were treated for 1 week. The clinical efficacy， levels of serum sST2, MPO, MMP-9, inflammatory factors and echocardiographic indexes before and after treatment, as well as occurrence of adverse reaction were compared between the two groups. Results The total effective rate of the observation group was higher than that of the control group ［97.7%（42/43） vs 71.4%（30/42）］(P<0.05). After treatment, the levels of serum sST2, MPO, MMP-9, interleukins-6, tumor necrosis factor-α, high sensitivity C-reactive protein, left ventricular end diastolic diameter, and left ventricular end systolic diameter of both groups decreased, and those of the observation group were lower than those of the control group［（81±6）μg/L vs （93±7）μg/L,（456±21）μg/L vs （499±22）μg/L,（63±7）μg/L vs （83±8）μg/L,（20±3）ng/L vs （26±4）ng/L,（15.1±2.0）ng/L vs （20.3±2.0）ng/L,（16.8±1.9）mg/L vs （27.2±2.7）mg/L,（51±3）mm vs （57±3）mm,（40±4）mm vs （45±4）mm］, while left ventricular ejection fraction of both groups increased, and that of the observation group was higher than that of the control group (all P<0.001). There was no significant difference in the rate of adverse reaction between the two groups(P>0.05). Conclusions Levosimendan can reduce the levels of serum sST2, MPO and MMP-9, inhibit inflammatory response, and improve cardiac function in elderly patients with AMI complicated with heart failure. It has high safety and good clinical effects in short-term treatment.