瑞舒伐他汀不同预处理对急性ST段抬高型心肌梗死后患者冠状动脉介入治疗后心肌再灌注及相关因素的影响  

Impact of different pre-treatment of rosuvastatin on the level of myocardial reperfusion and relevant factors in patients suffered from ST-segment elevation myocardial infarction underwent primary percutaneous coronary intervention

作　　者：卢青[1] 丁世芳[1] 陈志楠[1] 蒋桔泉[1] 龚志刚[1] 李志刚[1] 付文波[1] 周密[1] 

机构地区：[1]广州军区武汉总医院心血管内科,湖北武汉430070

出　　处：《中国心脏起搏与心电生理杂志》2016年第6期517-521,共5页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的探讨术前瑞舒伐他汀不同预处理对急性ST段型抬高心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PCI)患者心肌再灌注和相关因素的影响。方法按是否起病前服用他汀类药物超过3个月,将170例首次STEMI患者随机分为长期干预组45例、大剂量组64例和常规剂量组61例。术前、术后分别检测肌酸激酶同功酶(CK-MB)、肌钙蛋白(TnT)、超敏C反应蛋白(hs-CRP)、白介素-6(IL-6)及血脂水平;测定左室射血分数(LVEF),评价心肌再灌注情况;术后40天内观察主要心血管不良事件及药物不良反应的发生。结果 PCI术后长期干预组患者CK-MB、TnT峰值水平、hsCRP、IL-6值、心肌灌注水平与大剂量组比较无显著差异,2组均较常规剂量组明显改善(P均<0.05)。2组再发心绞痛、心力衰竭、严重室性心律失常发生率较常规剂量组明显降低,而LVEF则明显升高(P均<0.05)。结论 STEMI PCI患者长期或大剂量服用他汀药物较术前常规剂量预处理,可进一步提高患者心肌灌注,保护心肌,减少严重心律失常的发生。Objective To compare the level of myocardial reperfusion and relevant factors with different previous therapy of rosuvastatin in patients suffered from ST-segment elevation myocardial infarction（STEMI）underwent primary percutaneous coronary intervention（PCI）. Methods One hundred and seventy consecutive patients suffered from STEMI undergoing primary PCI were enrolled.According to the history with the chronic pre-treatment of statins,they were randomly divided into the group with chronic pre-treatment of statins（n=45）,high dose group（n=64）and conventional dose group（n=61）.Blood samplings were examined to measure biomarkers：CK-MB,TnT,hs-CRP,IL-6and lipids levels were repeated before and after PCI.Myocardial reperfusion was evaluated during PCI.Left ventricular ejection fraction（LVEF）was detected.The occurrence of major adverse cardiovascular events and adverse drug reactions were observed within 40 days after PCI. Results The levels of the biomarkers（CKMB,TnT,hs-CRP,IL-6and lipids）and myocardial reperfusion in the group with chronic pre-treatment of statins had no significantly difference with those in high dose group;those levels in the both groups were significantly better than those in the conventional dose group（all P〈0.05）.Compared with the conventional dose group,the incidence of angina pectoris post-PCI,heart failure and severe ventricular arrhythmia were significantly lower and LVEF was significantly higher in the other two groups（all P〈0.05）. Conclusion The pre-treatment with high dose or the chronic pre-treatment of statins for patients suffer from STEMI further alleviate the ischemic myocardial reperfusion,protect myocardial,and reduce the incidence of severe ventricular arrhythmia.

关 键 词：心血管病学 他汀 急性ST段抬高型心肌梗死 再灌注 经皮冠状动脉介入术 

分 类 号：R542.22[医药卫生—心血管疾病] R815[医药卫生—内科学]