强化阿托伐他汀对急性冠状动脉综合征患者选择性介入治疗围手术期的影响  

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

作　　者：于兴隆[1] 边培敏[2] 葛志明[1] 耿静[1] 吴婷婷[1] 申玉文[1] 陈文强[1] 季晓平[1] 张运[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 [2]济南市第五人民医院急诊科

出　　处：《中华老年心脑血管病杂志》2010年第12期1077-1080,共4页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

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(NSTEACS)患者PCI围手术期的影响。方法将81例NSTEACS患者随机分为负荷治疗组41例和标准治疗组40例,负荷治疗组PCI术前12 h顿服阿托伐他汀80 mg,PCI术前2 h追加阿托伐他汀40 mg。2组术前、术后8和24 h抽取肘静脉血,检测血清肌酸激酶同工酶(CK-MB)、血浆肌钙蛋白(cTnI)和高敏C反应蛋白(hs-CRP)等。随访30 d主要不良心脏事件发生率。结果与PCI术前比较,2组PCI术后CK-MB、cTnI和hs CRP均明显升高(P<0.01),但负荷治疗组CK-MB、cTnI和hs-CRP升高水平显著低于标准治疗组(P<0.01)。负荷治疗组心肌损伤标记物升高发生率较标准治疗组显著降低(7.3%vs 32.5%,P=0.003;24.4%vs 47.5%,P=0.030)。负荷治疗组主要不良心脏事件发生率较标准治疗组低(2.4% vs 22.5%,P=0.01 61),心肌梗死发生率下降(2.4%vs20.0%,P=0.0307)。结论 NSTEACS患者PCI术前应用阿托伐他汀负荷剂量,能减少PCI术对患者造成的心肌损伤及炎性反应,还可降低PCI术后不良心脏事件的发生,而且安全有效。Objectives To investigate the effect of loading dose atorvastatin on myocardial injury and inflammatory reaction in patients with non-ST segment elevation acute coronary syndrome （ACS） undergoing early percutaneous coronary intervention. Methods A total of 81 patients with non-ST segment elevation ACS were randomized to the group pretreated with atorvastatin 80 mg 12 h before PCI and with a further 40 mg preprocedure dose （n =41） or control group treated with standard method （n = 40）. CK-MB,cTnI and hs-CRP of the blood from elbow vein were monitored before and 8 and 24 hours after the PCI. Results Compared with before PCI, CK-MB, cTnI and hs-CRP of the two groups were elevated after PCI, however, the ascended values of CK-MB and cTnI were significantly lower in atorvastatin group than in control group （7. 3% vs 32.5%, P = 0. 003; 24. 4% vs 47. 5%, P = 0. 030, respectively）. The major adverse cardiac events occurred in 2. 4% of patients of atorvastatin group and 22. 5% in control group （P = 0. 0161）. This difference was mostly due to reduction of myocardial infarction incidence（2.4% vs 20.0%, P =0. 0307）. Conclusion Short-term pretreatment with high-dose atorvastatin can reduce myocardial injury and inflammatory reaction caused by PCI in patients with non-ST segment elevation ACS undergoing early PCI.

关 键 词：抗胆固醇血症药 吡咯类 庚酸类 急性冠状动脉综合征 手术期间 心肌 炎症 

分 类 号：R541.4[医药卫生—心血管疾病]