大剂量阿托伐他汀对急性心肌梗死患者心室重构的远期影响  

Long-term effect of large-dose atorvastatin on ventricular remodeling in the patients with acute myocardial infarction

作　　者：康海[1] 杨军[2] 方毅民[2] 任法新[2] 张秀珍[3] 林绍霞[4] 

机构地区：[1]青岛大学医学院附属烟台毓璜顶医院急救中心,山东烟台264000 [2]青岛大学医学院附属烟台毓璜顶医院心血管内科,山东烟台264000 [3]青岛大学医学院附属烟台毓璜顶医院超声科,山东烟台264000 [4]青岛大学医学院附属烟台毓璜顶医院检验科,山东烟台264000

出　　处：《中国急救医学》2008年第2期131-134,共4页Chinese Journal of Critical Care Medicine

基　　金：烟台市科学技术发展计划项目(No20061354)

摘　　要：目的探讨大剂量阿托伐他汀逆转急性心肌梗死(acute myocardial infarction,AMI)后心室重构的效果。方法91例急性ST段抬高心肌梗死(STEMI)患者入院后将低密度脂蛋白胆固醇(LDL-C)水平<2·6mmol/L的患者列为对照组;其余患者随机分为大剂量组(阿托伐他汀40mg/d),常规剂量组(阿托伐他汀10mg/d),连续用药24周。测血清Ⅲ型前胶原氨基末端肽(PⅢNP)、基质金属蛋白酶-9(MMP-9)及高敏C反应蛋白(hs-CRP)水平;应用超声心动图测量并计算左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)、左室射血分数(LVEF)、心室舒张早期左房室瓣血流峰值流速/心室舒张晚期左房室瓣血流峰值流速(VE/VA)、左室重量指数(LVMI)及室壁运动积分指数(WMSI)。结果①24周后大剂量组的LVESV、LVEDV、LVMI及WMSI均显著低于常规剂量组和对照组LVEF和VE/VF亦显著高于常规剂量组和对照组(P<0·01);常规剂量组与对照组比较差异有统计学意义(P<0·05)。②各组AMI后PⅢNP、MMP-9和hs-CPR均有不同程度的升高。大剂量组12周后的PⅢNP、MMP-9及hs-CRP水平显著低于常规剂量组和对照组(P<0·01);常规剂量组上述指标的水平亦显著低于对照组(P<0·05,P<0·01)。③PⅢNP、MMP-9及hs-CRP的变化幅度与LVEDV和LVEF的变化幅度之间有显著相关性。结论阿托伐他汀能够抑制AMI后的心室重构,改善心脏收缩和舒张功能,且增加剂量能够进一步增强其效应。Objective To investigate the effect of large - dose atorvastatin on ventricular remodeling and cardiac function in the patients with acute myocardial infarction （ AMI ）. Methods 91 patients with first acute ST segment elevation myocardial infarction were selected. In control group, low density lipoprotein cholesterol （ LDL - C ） of patients were lowered to 2.6 mmol/L and the others were divided into conventional - dose atorvastatin group （ 10 rag/day, for 24 weeks） or large - dose atorvastatin group（40 mg/day, for 24 weeks ） at random. Bv using transthoracic Doppler echocardiography, LVESV, LVEDV, LVMI, WMSI, LVEF and VE/VA were measured within 24 hours after AMI and 24 weeks later, respectively. The serum levels of PmNP, MMP -9 and hs - CRP were also measured within 24 hours after AMI and 24 weeks later, respectively. Results （1）Compared with conventional - dose atorvastatin group and the control group, the LVESV, LVEDV, LVMI and WMSI in large - dose atorvastatin group decreased significantly, and the levels of VE/VA and LVEF increased significantly（ P 〈0.01 ） , and there were significant differences in above - mentioned indexes between conventional - dose group and the control group 24 weeks later（ P 〈0, 05 ）. （2）12 weeks later, the levels of hs - CRP, MMP -9 and PmNP in large - dose atorvastatin group were significantly lower than those in both conventional - dose atorvastatin group and the control group （ P 〈 0.01 ）, whereas the levels of these in conventional - dose atorvastatin group were also lower than those in the control group significantly（ P 〈 0. 05 ,P 〈 0.01 ）. （3）There were significant correlation between serum levels of hs - CRP, MMP - 9, PⅢNP and LVEDV, LVEF. Conclusions Atorvastatin can suppress ventricular remodeling and improve cardiac systolic and diastolic function after AMI, and its effect could be further strengthened by increasing the dosage of atorvastatin.

关 键 词：阿托伐他汀 急性心肌梗死 心室重构 

分 类 号：R542.22[医药卫生—心血管疾病]