经皮冠状动脉介入前不同剂量阿托伐他汀对缓解心肌损伤的作用  

The effect of different dose atorvastatin therapy before percutaneous coronary intervention on myocardial injury

作　　者：李菁[1,2] 米树华[1,2] 吴学思[1,2] 周芸[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所特需医疗科,北京100029

出　　处：《心肺血管病杂志》2013年第5期549-552,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:研究不同剂量阿托伐他汀预处理,对经皮冠状动脉介入治疗(PCI)患者围手术期心肌损伤的保护作用。方法:选择心肌损伤标志物正常并择期PCI的的冠心病患者102例,包括稳定性心绞痛(SAP)44例,不稳定性心绞痛(UAP)58例,随机分为两组,大剂量组:术前3 d连续给予阿托伐他汀40 mg,小剂量组:予常规剂量10 mg。于术前及术后8 h、24 h测定肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、超敏C反应蛋白(hs-CRP);对比手术前后谷丙转氨酶(ALT)、肌酸激酶(CK)浓度;并对各指标在UAP和SAP不同人群中的变化进行分析。术后随访1个月了解心脏不良事件(MACE)发生率。结果:①术后8 h,两组cTnI、hs-CRP水平明显增高(P<0.05),术后24hCK-MB水平亦明显升高(P<0.05)。大剂量组术后cTnI、CK-MB、hs-CRP水平及心肌损伤标志物升高的发生率低于对照组,差异有统计学意义(P<0.05)②UAP患者中大剂量组的hs-CRP、cTnI、CK-MB浓度均明显低于对照组(P<0.05);而SAP患者,大剂量组仅hs-CRP浓度与对照组,差异有统计学意义(P<0.05)。结论:PCI术前短期给予大剂量阿托伐他汀能有效减少围手术期的心肌损伤。Objective ：To study the effect of different dose atorvastatin in reduction of myocardial injury in patients undergoing early percutaneous coronary intervention （PCI）. nethods：A total of 102 patients under- going PCI with stable angina pectoris （SAP） and unstable angina pectoris （UAP） were randomized to pretreat- ment with atorvastatin 40mg for 3 days prior to PCI or with a 10mg conventional dose. Creatine kinase-MB （ CK- MB）, troponin I （cTnI） and high sensitiveity C-reactive protine （hs-CRP） of the blood from elbow vein were measured at baseline and at 8 and 24 hours after the procedure. Creatine kinase （CK） and alanine aminotrans- ferase （ALT） were observed before and after PCI. We also detected the level of cardiac markers from SAP group and UAP group. All the patients were followed 1 month for major adverse cardiac events （MACE）. Re- suits： The level of cTnI and hs-CRP 8 hours after the PCI in the 2 groups were higher than that before the PCI （P 〈 0.05）. The content of CK-MB was also increased 24 hours after the PCI （P 〈 0.05）. The levels of post- operative cardiac markers in high-dose atorvastatin group were significantly lower than those in control group （ P 〈 0.05 ）. The incidences of the elevated cTnI and CK-MB in control group were higher than those in high - dose atorvastatin group （P 〈 0.05）. ~）The levels of post - operative hs-CRP and the cardiac markers in high- dose atorvastatin group were significantly lower than those in control group in UAP patients, but only the levels of hs-CRP obvious had difference between 2 group in SAP patients （P 〈 0.05 ）. Conclusion ： High - dose atorv- astatin in 3 successive days before PCI could significantly reduce the myocardial injury.

关 键 词：经皮冠状动脉介入治疗 心肌损伤 阿托伐他汀 

分 类 号：R54[医药卫生—心血管疾病]