服用螺内酯对缺血性心肌病行冠脉支架植入患者手术前后GATA4蛋白、低氧诱导因子-1α水平的影响

doi:10.5246/jcps.2022.02.011

中国药学(英文版) ›› 2022, Vol. 31 ›› Issue (2): 134-141.DOI: 10.5246/jcps.2022.02.011

服用螺内酯对缺血性心肌病行冠脉支架植入患者手术前后GATA4蛋白、低氧诱导因子-1α水平的影响

楼玉美¹^,²^,^*(), 葛晓颖²^,³, 郑哲岚⁴, 谢琳媛⁴, 廉姜芳¹, 沈文均¹, 楼钶楠¹, 胡万英¹, 胡德兴¹

1. 宁波市医疗中心李惠利医院心血管内科, 浙江宁波 315000
2. 宁波大学附属李惠利医院, 浙江宁波 315000
3. 宁波市医疗中心李惠利医院超声医学科, 浙江宁波 315000
4. 浙江大学医学院附属第一医院心血管超声中心, 浙江杭州 310000

收稿日期:2021-10-27 修回日期:2021-11-13 接受日期:2021-12-05 出版日期:2022-02-27 发布日期:2022-02-25
通讯作者: 楼玉美
作者简介:
+ Tel.: +86-0574-55835573, E-mail: louyumei01@163.com
基金资助:
Natural Science and Technology Fund of Ningbo Science and Technology Bureau (Grant No. 2017A610203), Yangtze River research project for sustainable development of hospitals in Zhejiang Province (Grant No. 2020ZHA-YZJ102).

The effect of spironolactone on the levels of GATA4 protein and hypoxia inducible factor-1α in patients receiving coronary stent implantation

Yumei Lou¹^,²^,^*(), Xiaoying Ge²^,³, Zhelan Zheng⁴, Linyuan Xie⁴, Jiangfang Lian¹, Wenjun Shen¹, Kenan Lou¹, Wanying Hu¹, Dexing Hu¹

1 Department of Cardiovascular Disease, Ningbo Medical Centre Lihuili Hospital, Ningbo 315000, Zhejiang, China
2 Ningbo University, Ningbo 315000, Zhejiang, China
3 Echocardiography and Vascular Ultrasound Center, Ningbo Medical Centre Lihuili Hospital, Ningbo 315000, Zhejiang, China
4 Echocardiography and Vascular Ultrasound Center, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310000, China

Received:2021-10-27 Revised:2021-11-13 Accepted:2021-12-05 Online:2022-02-27 Published:2022-02-25
Contact: Yumei Lou

摘要/Abstract

摘要：

研究旨在通过测定冠状动脉支架植入术患者手术前、后血清GATA4蛋白、低氧诱导因子-1α (HIF-1α)水平的变化, 探讨螺内酯对缺血性心肌病行冠状动脉支架植入术患者的心脏功能保护作用。通过PSM分组方法回顾性的选取2019年3月到2020年3月在我院接受缺血性心肌病行冠状动脉支架植入术患者134例, 其中服用螺内酯组患者67例作为实验组, 未服用螺内酯患者67例作为对照组。两组患者均在冠状动脉支架植入术术前、术后第24小时及术后半年测定血清中肌钙蛋白I、GATA4蛋白、HIF-1α水平; 两组患者在术前及术后半年分别进行常规经胸心脏彩超检查, 测量LVEF等数值, 并对动态心脏超声图像进行左心室收缩期峰值整体纵向应变(global longitudinal strain, GLS)进行测量。结果发现, HIF-1α水平: 实验组和对照组在术前、术后半年无显著差异, 但实验组在术后第24小时HIF-1α低于对照组 (P < 0.01)。GATA4蛋白: 实验组和对照组在术前、术后第24小时无显著差异, 但实验组在术后半年明显低于对照组(P < 0.01); 两组患者术前及术后LVEF无显著差异, 但术后半年两组GLS较术前均有改善, 且螺内酯组GLS改善更显著(P < 0.05)。因此可知, 螺内酯可能具有改善心肌缺氧及抑制心肌重构从而改善心功能的作用。

关键词: 冠状动脉支架植入术, 螺内酯, 低氧诱导因子-1α, GATA4蛋白, 缺血性心肌病, 左心室收缩期峰值整体纵向应变

Abstract:

In the present study, we aimed to explore the protective effect of spironolactone on cardiac function in patients undergoing coronary stent implantation by determining the serum levels of GATA4 and hypoxia-inducible factor-1α (HIF-1α) proteins before and after the coronary stent implantation. A total of 134 patients undergoing coronary stent implantation in our hospital from March 2019 to March 2020 were retrospectively selected using the propensity score matching (PSM) method. Of the 134 patients, 67 patients taking spironolactone were used as a test group, and the other 67 patients without taking spironolactone were used as a control group. In all patients, the levels of serum GATA4, HIF-1α, and troponin I proteins were determined before as well as 24 h and 6 months after the coronary stent implantation. Left ventricular ejection fraction (LVEF) and left ventricular systolic global longitudinal strain (GLS) were determined before and 6 months after the coronary stent implantation. There were no significant differences in the HIF-1α level between the two groups before and 6 months after the operation, while the HIF-1α level was significantly lower in the test group compared with the control group at 24 h after the operation (P < 0.01). There were no significant differences in the GATA4 protein level between the two groups before and 24 h after the operation, while the GATA4 protein level was significantly lower in the test group compared with the control group at 6 months after the operation (P < 0.01). There was no significant difference in LVEF between the two groups before and 6 months after the operation. GLS was significantly improved at 6 months after the operation compared with that before the operation in both groups, while GLS was significantly better in the test group compared with the control group at 6 months after the operation (P < 0.01). Collectively, spironolactone could protect cardiac function probably by improving myocardial hypoxia and inhibiting myocardial remodeling.

Key words: Coronary stent implantation, Spironolactone, Hypoxia-inducible factor-1α, GATA4 protein, Ischemic cardiomyopathy, Global longitudinal strain

Supporting:

楼玉美, 葛晓颖, 郑哲岚, 谢琳媛, 廉姜芳, 沈文均, 楼钶楠, 胡万英, 胡德兴. 服用螺内酯对缺血性心肌病行冠脉支架植入患者手术前后GATA4蛋白、低氧诱导因子-1α水平的影响[J]. 中国药学(英文版), 2022, 31(2): 134-141.

Yumei Lou, Xiaoying Ge, Zhelan Zheng, Linyuan Xie, Jiangfang Lian, Wenjun Shen, Kenan Lou, Wanying Hu, Dexing Hu. The effect of spironolactone on the levels of GATA4 protein and hypoxia inducible factor-1α in patients receiving coronary stent implantation[J]. Journal of Chinese Pharmaceutical Sciences, 2022, 31(2): 134-141.

图/表 5

Table 1. General data in patients of the two groups.

Figure 1. Longitudinal strain curve of the left ventricle on apical three-chamber view in a patient. Notes: GLS: global longitudinal strain; GLS = –15% in the figure (normal GLS ≤ –20%). The higher the GLS value, the poorer the left ventricular function[9,10].

Table 2. Levels of troponin (μg/L) and HIF-1α (pg/mL) before and after the coronary stent implantation in the two groups.

Table 3. GATA4 protein (ng/L) before and after the coronary stent implantation in the two groups.

Table 4. Comparisons of GLS and LVEF between before and 6 months after the operation in the two groups (%).

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服用螺内酯对缺血性心肌病行冠脉支架植入患者手术前后GATA4蛋白、低氧诱导因子-1α水平的影响

The effect of spironolactone on the levels of GATA4 protein and hypoxia inducible factor-1α in patients receiving coronary stent implantation

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