尼可地尔在经皮冠状动脉介入治疗中对NLRP3炎症小体的干预作用-东南大学学报医学版

尼可地尔在经皮冠状动脉介入治疗中对NLRP3炎症小体的干预作用

单位：广西柳州市工人医院心血管内科, 广西柳州 545005

分类号：R541.4

出版年·卷·期（页码）：2018·37·第三期（420-423）

摘要：

目的：探讨术前口服尼可地尔对经皮冠状动脉介入治疗（PCI）激活的Nod样受体蛋白3（NLRP3）炎症小体的干预作用，为临床上减轻PCI围术期心肌损伤提供理论依据。方法：入选入住我院心内科拟行择期PCI的冠心病不稳定型心绞痛患者80例，随机分为试验组42例和对照组38例，在常规药物治疗基础上，试验组于PCI术前3 d开始每日口服尼可地尔5 mg 3次，于PCI术前及术后24、48 h采集静脉血，比较两组患者NLRP3、白介素-1β（IL-1β）、超敏C反应蛋白（hs-CRP）、高敏肌钙蛋白T （hs-cTnT）的变化。结果：两组PCI情况比较差异无统计学意义（P>0.05）；试验组PCI术后24、48 h的NLRP3、IL-1β、hs-CRP、hs-cTnT水平均较对照组下降（P<0.05）。结论：术前口服尼可地尔可以减少PCI相关NLRP3炎症小体的释放，减轻PCI术后心肌炎症反应，从而保护心肌。

Objective: To explore the effect of oral nicorandil premedication on activated NLRP3 inflammasome in patients treated with percutaneous coronary intervention(PCI), and provide a theoretical basis for reducing myocardial injury in the perioperative period of PCI.Methods: A total of 80 cases with unstable angina undergoing PCI in the Department of cardiology were enrolled in this study. They were randomly divided into experimental group(n=42) and control group(n=38). On the basis of conventional drug treatment, oral nicorandil(5 mg) was given three times daily to patients in the experimental group for successive 3 days before PCI. The blood samples were collected before and 24, 48 hours after PCI. The changes of Nod like receptor protein 3(NLRP3), interleukin-1β(IL-1β), hypersensitive C reactive protein(hs-CRP) and hypersensitive troponin T(hs-cTn T) were observed and compared between the two groups.Results: There was no statistical difference between the experimental group and the control group in PCI(P>0.05). However, the levels of NLRP3, IL-1β, hs-CRP and hs-cTnT in the experimental group were lower than those in the control group 24 and 48 hours after PCI with statistical difference(P<0.05).Conclusion: Preoperative oral nicorandil can reduce the release of PCI related NLRP3 inflammasome, alleviate postoperative inflammatory reaction and protect the myocardium.

参考文献：

[1] SKYSCHALLY A,LEINEWEBER K,GRES P,et al.Coronary microembolization[J].Basic Res Cardiol,2006,101(5):373-382.
[2] NICCOLI G,SGUEGLIA G A,LATIB A,et al.Association of baseline C-reactive protein levels with periprocedural myocardial injury in patients undergoing percutaneous bifurcation intervention:a CACTUS study subanalysis[J].Catheter Cardiovasc Interv,2014,83(1):E37-44.
[3] 曲虹.替格瑞洛对PCI术后血清IL-6、TNF-α水平变化分析[J].现代医学,2017,45(6):785-789.
[4] HWANG J,LEE H C,KIM B W,et al.Effect on periprocedural myocardial infarction of intra-coronary nicorandil prior to percutaneous coronary intervention in stable and unstable angina[J].J Cardiol,2013,62(2):77-81.
[5] KIM J H,JEONG M H,YUN K H,et al.Myocardial protective effects of nicorandil during percutaneous coronary intervention in patients with unstable angina[J].Circ J,2005,69(3):306-310.
[6] PANG Z,ZHAO W,YAO Z.Cardioprotective effects of nicorandil on coronary heart disease patients undergoing elective percutaneous coronary intervention[J].Med Sci Monit,2017,23:2924-2930.
[7] van HOUT G P,BOSCH L,ELLENBROEK G H,et al.The selective NLRP3-inflammasome inhibitor MCC950 reduces infarct size and preserves cardiac function in a pig model of myocardial infarction[J].Eur Heart J,2017,38(11):828-836.
[8] 柯元南,陈纪林.不稳定性心绞痛和非ST段抬高心肌梗死诊断与治疗指南[J].中华心血管病杂志,2007(4):295-304.
[9] FATEMI O,TORGUSON R,CHEN F,et al.Red cell distribution width as a bleeding predictor after percutaneous coronary intervention[J].Am Heart J,2013,166(1):104-109.
[10] LANZA G A,PARRINELLO R,FIGLIOZZI S.Management of microvascular angina pectoris[J].Am J Cardiovasc Drugs,2014,14(1):31-40.
[11] ZHAO A P,DONG Y F,LIU W,et al.Nicorandil inhibits inflammasome activation and Toll-like receptor-4 signal transduction to protect against oxygen-glucose deprivation-induced inflammation in BV-2 cells[J].CNS Neurosci Ther,2014,20(2):147-153.
[12] WANG L,QU P,ZHAO J,et al.NLRP3 and downstream cytokine expression elevated in the monocytes of patients with coronary artery disease[J].Arch Med Sci,2014,10(4):791-800.
[13] AFRASYAB A,QU P,ZHAO Y,et al.Correlation of NLRP3 with severity and prognosis of coronary atherosclerosis in acute coronary syndrome patients[J].Heart Vessels,2016,31(8):1218-1229.
[14] COLL R C,ROBERTSON A A,CHAE J J,et al.A small-molecule inhibitor of the NLRP3 inflammasome for the treatment of inflammatory diseases[J].Nat Med,2015,21(3):248-255.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录