负荷量他汀对急性冠脉综合征择期经皮冠脉介入治疗术后细胞凋亡及心肌损伤和临床事件的影响  

Effects of Loading-dose Atorvastatin on Apoptosis,Myocardial Damage and Major Adverse Cardiac Events in Acute Coronary Syndrome Patients Undergoing Selected Percutaneous Coronary Intervention

作　　者：朱记法[1,2] 马虹[1] 李怡[1] 

机构地区：[1]中山大学第一附属医院心内科,广东广州510080 [2]郑州大学第一附属医院心内科,河南郑州450000

出　　处：《中山大学学报（医学科学版）》2011年第1期67-70,80,共5页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省科技计划项目(2007B080701031)

摘　　要：【目的】探讨急性冠脉综合征患者择期经皮冠脉介入术前给予负荷量阿托伐他汀对细胞凋亡、心肌损伤及术后主要不良心血管事件的影响。【方法】入选2008年11月至2009年7月在我院行择期冠脉介入术的急性冠脉综合征连续病例85例,随机分为试验组和对照组,分别为42例和43例。试验组在阿托伐他汀20 mg/d基础上,术前8 h再给予负荷量阿托伐他汀80 mg,对照组仅给予阿托伐他汀20 mg/d。分别在术前,术后6 h及术后24 h检测凋亡因子Fas,术前及术后24 h检测心肌损伤标记物肌钙蛋白T(cTnT),并随访术后3个月内的主要不良心血管事件。【结果】试验组Fas水平在PCI术前,术后6 h及24 h依次降低,但差异无统计学意义。在对照组,术后24 hFas水平较术后6 h有升高趋势(P=0.056)。试验组与对照组间比较,两组术前与术后6 h细胞凋亡因子Fas水平差异无统计学意义;术后24 h试验组细胞凋亡因子Fas水平较对照组明显降低,两组比较差异有统计学意义。试验组心肌损伤标记物cTnT在PCI术后24 h较术前降低,差异有统计学意义。对照组术后24 h较术前升高,但差异无统计学意义。试验组与对照组间比较,试验组cTnT在术后24 h明显低于对照组。随访3个月,试验组有6例患者发生主要不良心血管事件,对照组有14例患者发生不良心血管事件,差异有统计学意义。【结论】本研究初步表明,急性冠脉综合征患者择期PCI术后细胞凋亡因子Fas水平有增高趋势,术前8 h给予负荷量阿托伐他汀能够降低术后细胞凋亡因子Fas水平,并能减轻心肌损伤,减少术后3个月内的主要不良心血管事件。【Objective】 To investigate the effects of loading-dose atorvastatin on apoptosis,myocardial damage and major adverse cardiac events（MACE） in patients with acute coronary syndrome undergoing selected percutaneous coronary intervention（PCI）.【Methods】 A total of eighty-five acute coronary syndrome patients undergoing selected PCI were randomized to study group（n = 42） and control group（n = 43）.All patients were given atorvastatin 20 mg/d,while study group received loading-dose atorvastatin 80 mg before 8 hours of PCI.Fas,which is involved in the physiopathological process of apoptosis,was measured before PCI,6 hours and 24 hours after PCI.Troponin T（cTnT） was measured before PCI and 24 hours after PCI.MACE in 3 months after PCI was recorded.【Results】 In study group,The Fas levels before PCI as well as 6 hours and 24 hours after PCI were decreased sequentially,but the differences were not statistically significant.In control group,the Fas level measured 24 hours after PCI had an increasing tendency as compared with that measured 6 hours after PCI（P = 0.056）.Compared between study group and control group,the Fas levels both in study group and control group measured before PCI and 6 hours after PCI were similar;The Fas level in study group was lower than that in control group 24 hours after PCI（P = 0.013）.The cTnT level was decreased measured 24 hours after PCI in study group（P 0.001）,but not changed in control group.The cTnT level measured 24 hours after PCI was significantly lower in study group than that in control group（P = 0.03）.The MACE in 3 months after PCI in study group was less than that in control group.【Conclusion】 This study demonstrated that selected PCI could induce the increase of Fas level after PCI in patients with acute coronary syndrome.And loading-dose atorvastatin used before 8 hours of PCI could decrease the levels of Fas as well as cTnT measured 24 hours after PCI,also reduce the occurrence of MACE in 3 months after PCI.

关 键 词：经皮冠脉介入治疗 细胞凋亡 阿托伐他汀 

分 类 号：R54[医药卫生—心血管疾病]