高剂量他汀对急性心肌梗死患者血小板功能及心室重构的影响  

Effects of high dose atorvastatin administration on platelet activities and ventricular remodeling of patients with acute myocardial infarction

作　　者：李韶南[1] 刘震[1] 黄慧芳[1] 陈平安[1] 雷晓明[1] 

机构地区：[1]广州市第一人民医院心内科,广州510180

出　　处：《中国医师杂志》2015年第4期519-523,共5页Journal of Chinese Physician

基　　金：广东省科技计划资助项目（20118031800113）

摘　　要：目的 评价负荷剂量联合高维持剂量阿托伐他汀治疗对急性ST段抬高心肌梗死（STEMI）患者血小板活化参数以及接受直接经皮冠状动脉介入（PCI）治疗后心室重构的影响与机制.方法 选择2012年6月至2013年12月在本院心内科住院并诊断为STEMI的患者260例,随机分为对照组（常规剂量组）140例及高剂量他汀组120例,检测患者直接PCI术前及术后平均血小板体积（MPV）、大血小板比例（P-LCR）、血小板活化指标CD62p、糖蛋白（Gp）Ⅱb/Ⅲa受体复合物（PAC-1）水平,记录直接PCI术后患者心肌灌注指标TIMI心肌灌注分级（TMPG）;患者于术后5～7d及出院6个月后行超声心动图测定左室舒张末期容积（LVEDV）、左室收缩末期容积（LVESV）、左室质量指数（LVMI）及左室射血分数（LVEF）.术后对患者随访6个月,动态追踪观察两组患者随访期内肝功能损害、肌病及心血管不良事件（MACE）的发生情况.结果 高剂量组患者术后MPV、P-LCR、CD62p 、PAC-1等血小板活化参数均低于对照组[（12.96±1.73）fl vs （14.18±1.86）fl,P＜0.05;（29.12±5.83）％ vs （30.66 ±6.12）％,P＜0.05;（45.36±5.24）％ vs （48.44±4.75）％,P＜0.01;（74.61±5.57）％ vs （78.55±5.78）％,P＜0.01],术后TMPG良好比例显著高于对照组（73.3％ vs 58.6％,P＜0.01）,出院6个月后,高剂量组患者LVEDV、LVESV、LVMI显著小于对照组,而LVEF则高于对照组[（110.46±8.86）ml vs（112.61±8.5）ml,P＜0.01;（60.16±6.13）ml vs（63.52±5.54）ml,P＜0.01;（101.69±4.35）g/m2 vs （103.96±4.17）g/m2,P＜0.05;（50.08±3.78）％ vs （48.47±4.12）％,P＜0.05],随访期间两组患者肝功能损害及肌病的发生情况差异无统计学意义（P＞0.05）,Kaplan-Meier生存分析显示高剂量组患者累积无MACE事件生存率显著高于对照组,Log rank检验差异有统计学意义（91.7％ vs 82.4％,Log rank =4.409,P=0.036）.结论 对STEMI患者应用高剂�Objective To investigate the effects of high dose atovastatin administration on platelet activity and ventricular remodeling of patients with ST-Segment elevation myocardial infarction （STEMI） underwent primary percutaneous coronary intervention （PCI）.Methods A total of 260 STEMI patients who hospitalized in our Department of Cardiology from June 2012 to December 2013 was enrolled and randomly divided into two groups：controlled group （n =140） and high dose atorvastatin group （n =120）.Indicators of platelet activities including mean platelet volume （MPV）,platelet large cell ratio （P-LCR）,blood CD62p,and glucose protein Ⅱ b/Ⅲa （PAC-1） were measured before and 48 hours after PCI.TIMI myocardial perfusion grade （TMPG） after PCI was recorded and patients accepted ultrasound cardiogram （UCG） examinations 5 ～7 days after PCI and 6 months after discharge.After PCI,Patients were followed up for 6 months,statin-associated liver impairment,myopath and major adverse cardiac events （MACE） happened during follow-up periods were recorded.Results MPV,P-LCR,CD62p,and PAC-1 in patients of high dose atorvastatin group were less than controlled group and TMPG were better than controlled group [（12.96±1.73）fl vs （14.18 ± 1.86）fl,P 〈0.05;（29.12 ±5.83）% vs （30.66 ±6.12）%,P 〈 0.05;（45.36±5.24）% vs （48.44±4.75）%,P 〈0.01;（74.61 ±5.57）% vs （78.55±5.78）%,P 〈0.01].Six months after PCI,UCG examination showed that Left ventricular end-diastolic volume （LV-EDV）,left ventricular end-systolic volume （LVESV） and left ventricular mass index （LVMI） in high dose group were less than controlled group while the left ventricular ejection fraction （LVEF） was higher than controlled group [（110.46 ±8.86）ml vs （112.61 ±8.5）ml,P 〈0.01;（60.16 ±6.13）ml vs （63.52 ± 5.54）ml,P 〈0.01;（1O1.69±4.35）g/m2 vs （103.96 ±4.17）g/m2,P 〈0.05;（50.08 ±3.78）% vs （48.47 ± 4.12） %,P 〈 0.05].After 6 months of follow-up,the

关 键 词：庚酸类/投药和剂量 吡咯类/投药和剂量 心肌梗死/病理生理学/药物疗法 血小板/药物作用 心室重构/药物作用 

分 类 号：R542.22[医药卫生—心血管疾病]