Marfella Raffaele, Rizzo Maria Rosaria, Siniscalchi Mario, Paolisso Pasquale, Barbieri Michelangela, Sardu Celestino, Savinelli Antonella, Angelico Nicola, Del Gaudio Salvatore, Esposito Nicolino, Rambaldi Pier Francesco, D'Onofrio Nunzia, Mansi Luigi, Mauro Ciro, Paolisso Giuseppe, Balestrieri Maria Luisa
Department of Geriatrics and Metabolic Diseases Second University of Naples, Italy.
Int J Cardiol. 2013 Oct 9;168(4):3954-62. doi: 10.1016/j.ijcard.2013.06.053. Epub 2013 Jul 19.
We examined the effects of peri-procedural intensive glycemic control during early percutaneous coronary intervention (PCI) on the number and differentiation of endothelial progenitor cells (EPCs) and myocardial salvage (MS) in hyperglycemic patients with first ST-elevation myocardial infarction (STEMI).
We conducted a randomized, prospective, open label study on 194 patients with STEMI undergoing PCI: 88 normoglycemic patients (glucose < 140 mg/dl) served as the control group. Hyperglycemic patients (glucose ≥140 mg/dl) were randomized to intensive glycemic control (IGC) for almost 24 h after PCI (n = 54; 80-140 mg/dl) or conventional glycemic control (CGC, n = 52; 180-200 mg/dl). EPC number, differentiation, and SIRT1expression were assessed immediately before, 24 h, 7, 30 and 180 days after PCI. The primary end point of the study was salvage index, measured as the proportion of initial perfusion defect (acute technetium-99m sestamibi scintigraphy, performed 5 to 7 days after STEMI) and myocardium salvaged by therapy (6 months after STEMI). Hyperglycemic patients had lower EPC number and differentiation and lower SIRT1 levels than normoglycemic patients (P < 0.01). After the insulin infusion, mean plasma glucose during peri-procedural period was greater in CGC group than in IGC group (P < 0.001). The EPC number, their capability to differentiate, and SIRT1 levels were significantly higher in IGC group than in CGC, peaking after 24 h (P < 0.01). In the IGC group, the salvage index was greater than in patients treated with CGC (P < 0.001).
Optimal peri-procedural glycemic control, by increasing EPC number and their capability to differentiate, may improve the myocardial salvage.
我们研究了早期经皮冠状动脉介入治疗（PCI）期间围手术期强化血糖控制对首次ST段抬高型心肌梗死（STEMI）高血糖患者内皮祖细胞（EPCs）数量、分化及心肌挽救（MS）的影响。
我们对194例接受PCI的STEMI患者进行了一项随机、前瞻性、开放标签研究：88例血糖正常患者（血糖<140mg/dl）作为对照组。高血糖患者（血糖≥140mg/dl）被随机分为PCI术后近24小时强化血糖控制（IGC，n=54；80-140mg/dl）或传统血糖控制（CGC，n=52；180-200mg/dl）。在PCI术前、术后24小时、7天、30天和180天评估EPC数量、分化及SIRT1表达。研究的主要终点是挽救指数，通过初始灌注缺损（STEMI后5至7天行急性锝-99m甲氧基异丁基异腈闪烁扫描）与治疗挽救的心肌（STEMI后6个月）的比例来衡量。高血糖患者的EPC数量、分化及SIRT1水平低于血糖正常患者（P<0.01）。胰岛素输注后，CGC组围手术期平均血浆葡萄糖水平高于IGC组（P<0.001）。IGC组的EPC数量、分化能力及SIRT1水平显著高于CGC组，在术后24小时达到峰值（P<0.01）。在IGC组，挽救指数高于接受CGC治疗的患者（P<0.001）。
围手术期最佳血糖控制通过增加EPC数量及其分化能力，可能改善心肌挽救。
