负荷剂量阿托伐他汀对非ST段抬高急性冠状动脉综合征经皮冠状动脉介入治疗预后影响的研究  

Effect of loading dose atorvastatin on patients with acute coronary syndromes undergoing early percutaneous coronary intervention

作　　者：于兴隆[1] 耿静[1] 吴婷婷[1] 刘光辉[1] 郭雪原[1] 陈文强[1] 季晓平[1] 张运[1] 葛志明[1] 

机构地区：[1]山东大学齐鲁医院心内科教育部和卫生部心血管重构和功能研究重点实验室,济南250012

出　　处：《中国实用内科杂志》2010年第9期820-822,共3页Chinese Journal of Practical Internal Medicine

摘　　要：目的探讨负荷剂量阿托伐他汀对非ST段抬高急性冠状动脉综合征(NSTE-ACS)患者经皮冠状动脉介入治疗(PCI)后的影响。方法将2009年6—10月山东大学齐鲁医院收集的81例NSTE-ACS患者随机分为负荷组和对照组,负荷组PCI前12h顿服阿托伐他汀80mg,术前2h追加阿托伐他汀40mg。所有患者于术前和术后8h、24h抽取肘静脉血检测肌酸激酶同工酶(CK-MB)、血浆肌钙蛋白(cTNI)和超敏C反应蛋白(hs-CRP)、肌酸激酶(CK)、转氨酶(ALT/AST)。结果 PCI术后2组心肌损伤及炎性反应标志物均有不同程度升高,但负荷组CK-MB、cTNI和hs-CRP水平显著低于对照治疗组(均P<0.01)。负荷组主要不良心脏事件发生率(2.4%)小于对照组(22.5%)(P=0.0161),主要由心肌梗死发生率下降(2.4%对20.0%,P=0.0307)构成。2组患者药物副反应轻微。结论 PCI前阿托伐他汀负荷剂量能减少PCI对NSTE-ACS患者造成的心肌损伤及炎症反应。降低PCI后不良心脏事件的发生,且安全有效。Objective To investigate the effect of loading dose atorvastatin on myocardial injury and inflam- matory reaction in patients with non-ST segment elevation acute coronary syndromes （ACS）undergoing early percutaneous coronary intervention. Methods A total of 81 patients with non-ST segment elevation ACS were ran- domized to pretreatment with atorvastatin （ 80 mg 12 h before PCI, with a further 40 mg preprocedure dose （ n = 41 ） or placebo group（ n = 40 ） , CK-MB, cTnI, hs-CRP, CK and ALT/AST of the blood from elbow vein were moni- tored before and 8 and 24 hours after the procedure of PCI. The main end point of the trial was a 30-day incidence of major adverse cardiac events. Results The markers of two groups were elevated after PCI ,however, the ascen- ded values of CK-MB, cTnI, hs-CRP in the atorvastatin treatment group were significantly lower than those of the placebo group（P 〈 0.01 ）. the major adverse cardiacb events occurred in 2.4% of patients in the atorvastatin group and 22. 5% of those in the placebo group （P = 0. 0161 ）. This difference was mostly driven by reduction of myocardial infarction incidence （2.4% vs 20. 0% ） （P = 0. 0307）. Conclusion even short-term pretreatment with high dose atorvastatin may improve outcomes in patients with non-ST segment ACS undergoing early invasive strategy.

关 键 词：经皮冠状动脉介入治疗 心肌损伤 炎症反应 阿托伐他汀 

分 类 号：R5[医药卫生—内科学]