Iliodromitis E K, Kyrzopoulos S, Paraskevaidis I A, Kolocassides K G, Adamopoulos S, Karavolias G, Kremastinos D T
2nd University Department of Cardiology, Medical School, Attikon General Hospital, University of Athens, Athens, Greece.
Heart. 2006 Dec;92(12):1821-6. doi: 10.1136/hrt.2006.089060. Epub 2006 Jul 19.
To investigate whether remote ischaemic preconditioning (RIPC) can attenuate the inflammatory response and enzyme leakage that can occur after uncomplicated routine percutaneous coronary intervention (PCI).
41 consecutive normotensive patients with stable angina and single-vessel disease were assigned to be exposed to RIPC (n = 20) or not (control group; n = 21) before elective PCI with stent implantation. RIPC was induced by three cycles of 5-min ischaemia-reperfusion of both upper limbs (inflation/deflation of blood pressure cuff). C reactive protein (CRP), creatine phosphokinase (CK), CK cardiac isoenzyme (CK-MB) and troponin I (TNI) were serially measured for 48 h.
No difference in baseline values was observed between the groups. The CRP rose significantly (p<0.001) and at 48 h was similarly increased (>fourfold) in both groups (15.7 (2.6) v 14.0 (3.3) mg/l, RIPC v control; p = NS). However, sub-group analysis on the basis of statin use showed that the highest rise was in the group of patients with RIPC not taking statins and was significantly greater than in patients with RIPC taking statins (23.8 (3.71) v 11.4 (3.0) mg/l, respectively, p<0.01). Both CK-MB and TNI leakage were raised (slightly but significantly) after PCI in controls at 24 h compared with baseline values. However, this small rise was significantly worse after RIPC (CK-MB, 1.33 (0.27) v 3.57 (0.97) ng/ml, p<0.01; TNI, 0.255 (0.059) v 0.804 (0.232) ng/ml, p<0.05, respectively at 24 h). The increase was more marked in the RIPC subgroup not taking statins.
RIPC does not reduce, but exacerbates, the enzyme and TNI release from the heart after single-vessel angioplasty with stent. Furthermore, the increased circulating CRP remains raised. It seems that there is an enhanced inflammatory response after RIPC in the absence of statin treatment.
研究远程缺血预处理（RIPC）是否能减轻单纯常规经皮冠状动脉介入治疗（PCI）后可能出现的炎症反应和酶泄漏。
41例连续入选的血压正常、患有稳定型心绞痛且为单支血管病变的患者在择期PCI并植入支架前被分为接受RIPC组（n = 20）和未接受RIPC组（对照组；n = 21）。RIPC通过对双上肢进行三个周期的5分钟缺血再灌注（血压袖带充气/放气）诱导产生。连续48小时测量C反应蛋白（CRP）、肌酸磷酸激酶（CK）、CK心肌同工酶（CK-MB）和肌钙蛋白I（TNI）。
两组间基线值无差异。CRP显著升高（p<0.001），48小时时两组均有类似程度的升高（超过四倍）（RIPC组为15.7（2.6）mg/l，对照组为14.0（3.3）mg/l；p = 无显著性差异）。然而，基于他汀类药物使用情况的亚组分析显示，未服用他汀类药物的RIPC组患者CRP升高幅度最大，且显著高于服用他汀类药物的RIPC组患者（分别为23.8（3.71）mg/l和11.4（3.0）mg/l，p<0.01）。与基线值相比，对照组PCI后24小时CK-MB和TNI泄漏均有所升高（虽轻微但显著）。然而，RIPC后这种小幅度升高更为明显（24小时时，CK-MB：1.33（0.27）ng/ml对3.57（0.97）ng/ml，p<0.01；TNI：0.255（0.059）ng/ml对0.804（0.232）ng/ml，p<0.05）。未服用他汀类药物的RIPC亚组中升高更为明显。
RIPC不能减少单支血管支架成形术后心脏的酶和TNI释放，反而会使其加剧。此外，循环中升高的CRP仍居高不下。在未进行他汀类药物治疗的情况下，RIPC后似乎存在增强的炎症反应。
