负荷量阿托伐他汀降低冠状动脉介入术围手术期心血管事件作用和机制的探讨  

Effects and mechanisms of loading dosage of atorvastatin in reducing periprocedural cardiovascular events in patients undergoing percutaneous coronary intervention

作　　者：刘广安[1] 刘峰[2] 陈润祥[2] 程海[2] 刘建平[1] 

机构地区：[1]上海交通大学医学院附属仁济医院心内科,上海200001 [2]上海交通大学医学院附属苏州九龙医院心内科,江苏苏州215021

出　　处：《实用临床医药杂志》2011年第9期20-22,28,共4页Journal of Clinical Medicine in Practice

摘　　要：目的探讨负荷量阿托伐他汀减少冠状动脉介入治疗(PCI)围手术期心血管不良事件的机制。方法将58例冠心病行PCI治疗患者随机分为负荷量组30例和对照组28例,2组术后30 d均口服阿托伐他汀40 mg/d,并分别检测PCI前、PCI后24 h及10 d的脂蛋白相关磷脂酶A2(Lp-PLA2)、高敏C反应蛋白(hs-CRP)、ALT和CK等指标,随访所有患者PCI后30d内心血管事件。结果①2组所有病例血清Lp-PLA2和hs-CRP水平在PCI后10 d比PCI前和PCI后24 h均有显著下降(P<0.01);②负荷量组hs-CRP在PCI后24 h比对照组明显下降(P<0.05),Lp-PLA2水平仅轻度下降,组间无差异。Lp-PLA2和hs-CRP在PCI前和PCI后10 d组间均无差异;③负荷量组PCI前后ALT和CK水平变化无统计学差异而负荷量组PCI后30 d内心血管事件较对照组明显下降21.7%(P<0.05)。结论负荷量阿托伐他汀具有更强的抑制炎症反应作用,能进一步降低冠心病围手术期心血管事件风险并且安全可靠。Objective To evaluate the mechanisms of loading dosage of atorvastatin in reducing cardiovascular events in patients undergoing percutaneous coronary intervention（PCI）.Methods Fifty-eight patients who had been diagnosed with coronary heart disease（CHD） and would receive PCI were randomized to loading dosage group（n=30） and routine group（n=28）.All patients received atorvastatin treatment at least 30 days thereafter（40 mg/day）.The levels of serum Lp-PLA2,hs-CRP,Aminotransferase（ALT） and Creatine kinase（CK） at different time（before PCI,24 hours after PCI and 10 days after PCI） were tested.30-day incidence of major adverse cardiac events was done in a follow-up.Results ① The levels of serum Lp-PLA2 and hs-CRP in two groups decreased dramatically 10 days after PCI.There were significant differences when PCI 10 d to PCI 24 h and pre-PCI were compared（P0.01）.② The hs-CRP in loading group decreased dramatically after PCI 24 h,which was statistically different（P=0.02） between the two groups,but the Lp-PLA2 decreased lightly and there was no difference（P0.05） between two ones after PCI 24 h.There were no statistical differences at different time（before PCI and 10 days after PCI） of the two inflammation factors（P0.05） between two groups.③ The incidence of ardiovascular events in loading group decreased 21.7% than routine group（P0.05） and the ALT and CK showed no statistical differences before and after PCI（P0.05） in loading group.Conclusion Loading dosage of atorvastatin depresses inflammation activity stronger and would reduce cardiovascular events further during CHD periprocedural period and loading dosage of atorvastatin is credible and believable.

关 键 词：脂蛋白相关性磷脂酶A2 高敏C反应蛋白 阿托伐他汀 炎症因子 心血管事件 

分 类 号：R541.4[医药卫生—心血管疾病]