阿托伐他汀联合普罗布考对择期经皮冠状动脉介入治疗术后心肌损伤保护作用研究  

Impact of atorvastatin and probucol combination therapy on myocardial injury in patients with angina pectoris experiencing elective percutanous coronary intervention.

作　　者：张茹艳[1] 李健[2] 丛洪良[2] 李曦铭[2] 胡越成[2] 张迎怡[2] 赵茹[2] 

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市胸科医院心内科,天津300051

出　　处：《中国实用内科杂志》2014年第1期65-68,共4页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(51171058);天津市科技计划重点项目(12ZCZDSY03200);天津市卫生局科技重点攻关项目(10KG122;10KG121;11KG121);天津市卫生局科技基金(2011KZ64)

摘　　要：目的研究术前联用不同剂量阿托伐他汀与普罗布考对择期接受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及可能机制。方法入选2010年5—11月于天津市胸科医院101例接受择期PCI的冠心病心绞痛患者,随机分为标准联合剂量组24例,阿托伐他汀每晚顿服20 mg及普罗布考500 mg 2次/d;强化联合剂量组38例,阿托伐他汀每晚顿服40 mg及普罗布考500 mg 2次/d,术前2 h顿服阿托伐他汀40 mg普罗布考500 mg;强化剂量组39例,阿托伐他汀每晚顿服40 mg,术前2 h顿服阿托伐他汀40 mg。所有患者均于用药前和术后24 h抽取静脉血检测血脂和心肌坏死标志物(CK、CK-MB和TnI),并用酶联免疫法(ELISA)测定用药前及术后24 h髓过氧化物酶(MPO)。结果 (1)强化联合剂量组术后与术前CK-MB的差值小于标准联合剂量组(P<0.05),其术前与术后TnI的差值小于其他两组(P<0.05)。(2)三组患者术后血脂均较术前减低,但血脂差值在三组差异无统计学意义(P>0.05)。(3)强化联合剂量组术后MPO较术前减低(P<0.05),PCI术后与术前MPO差值小于另外2组(P<0.05)。结论阿托伐他汀与普罗布考强化联合治疗能够减少PCI术后心肌损伤;这种对PCI术后心肌的保护作用不单纯依赖于血脂降低,其可能机制是抑制MPO等炎症反应因子。Objective To investigate the protective effects of different doses of atorvastatin combined with probucol against myocardial injury in patients undergoing percutaneous coronary intervention （PCI） and its possible mechanism. Methods A total of 101 cases were enrolled and randomly divided into 3 groups ： standard combined treatment group （ n = 24, atorvas- tatin 20 mg qn and probucol 500 mg bid）, intensively combined treatment group （ n = 38, atorvastatin 40 mg qn and probu- col 500 mg bid,intake of atorvastatin bolus 40 mg and probucol 500 mg 2 hours before PCI） ,and intensive atorvastatin ther- apy group （ n = 39, atorvastatin 40 mg qn,intake of atorvastatin bolus 40 mg 2 hours before PCI）. Blood was drawn before intake of drugs and 24 h after PCI to measure the serum lipid profile, myocardial necrosis markers （CK, CK-MB and TnI） and serous myeloperoxidase （MPO）. Results （ 1 ） The pre/post-PCI change of CK-MB was less in intensively combined treatment group than that in standard combined treatment group （ P 〈 0.05 ）, and the pre/post-PCI change of TnI was less than that in other two groups （P 〈 0.05 ）. （2） The values of serum lipid profile 24 h after PCI were lower in all groups, while no statistically differences of pre/post-PCI change of serum lipid profile existed between groups （P 〉 0. 05）. （3） The serous level of MPO after PCI in intensively combined treatment group was lower than that of pre-PCI （P 〈 0. 05） ; serum chane of MPO pre/post-PCI in intensively combined treatment group was less than that in the other two groups （ P 〈0. 05）. Conclusion The intensively combined therapy of atorvastatin and probucol before PCI can significantly reduce peri-operative myocardial injury in patients The protective effect is dependent on not only lowering lipids, but also possibly in hibiting inflammatory reaction.

关 键 词：冠状动脉介入治疗 心肌损伤 髓过氧化物酶 炎症反应 

分 类 号：R541.4[医药卫生—心血管疾病]