他汀类对低低密度脂蛋白胆固醇急性冠状动脉综合征患者介入术后的心肌保护作用  

The role of statins in protection of periprocedural myocardium in patients with ACS combined with low level LDL-C undergoing PCI

作　　者：卜聪亚[1,2] 周玉杰[1,2] 史冬梅[1,2] 马涵英[1,2] 赵迎新[1,2] 刘宇杨[1,2] 李月平[1,2] 王龙华[1,2] 谢英[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院心内科12病房 [2]北京心肺血管疾病研究所

出　　处：《中华老年心脑血管病杂志》2011年第2期145-147,共3页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

摘　　要：目的观察合并有低LDL-C的急性冠状动脉综合征(ACS)患者行PCI后,他汀类药物对于围手术期心肌损伤的保护作用。方法合并有低LDL-C血症并同时具备PCI指征的ACS患者220例,根据治疗方法不同随机分为2组:PCI术前服用他汀类药物治疗116例(他汀组),不服用他汀类药物治疗104例(常规组),分别测量PCI术前及PCI术后6 h肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)及高敏C反应蛋白(hs-CRP)水平,评估2组患者随访3个月的主要心血管事件。结果他汀组与常规组患者术前cTnI、CK MB和hs-CRP比较,差异无统计学意义。他汀组患者术后CK MB、cTnI较常规组明显降低[(14.2±5.78 U/L vs(47.3±1 6.4)U/L,P<0.05;(0.36±0.1 2)μg/L vs(1.33±0.47)μg/L,P<0.01]。2组患者的hs-CRP水平及随访3个月的主要心血管事件没有明显的差异。结论对合并有低LDL-C的ACS患者实施他汀类预处理具有心肌保护作用,其机制可能与他汀类药物改善冠状动脉微循环的作用相关。但是这种预处理对于PCI术后3个月的主要心血管事件没有明显的改善。Objective To investigate the role of statins in protection against periprocedural myocardial damage in patients with ACS combined with low level LDL-C undergoing PCI. Methods 220 consecutive ACS patients with low level LDL-C（LDL-C〈2.6mmol/L） undergoing PCI were divided into two groups according to different treatment ：116 patients receiving statin treatment be- fore PCI（statin group）, 115 without（non-statin group）. Troponin-I（cTnI）,creatine kinase-myocardial band（CK-MB）,and high-sensitivity C reactive protein（hs-CRP） were measured before and 6 hr after PCI. Results No differences were found in eTnI,CK-MB and hs-CRP between statin group and non-statin group before PCI. The levels of CK-MB and cTnI were significantly lower in statin group than in the non-statin group[（14.2±5.78） U/L vs （47.3±16.4） U/L, P 〈 0.05; （0.36±0.12） μg/L vs （1.33±0.47） μg/L, P 〈 0.01] after PCI,while no difference in hs-CRP was seen between the 2 groups. There were no important differences in major cardiac vascular events during 3 month follow-up period between the 2 groups. Conclusion This study indicates that statin treatment play the role in protection of myocardium of patients with ACS combined with low level LDL-C undergoing PCI, the mechanism may be related to its improving mieroeireulation effect. However, no significant improvement in major cardiac vascular events in 3 month was found with such pretreatment.

关 键 词：急性冠状动脉综合征 降血脂药 胆固醇 LDL 肌钙蛋白 C反应蛋白质 手术期间 

分 类 号：R541.4[医药卫生—心血管疾病]