不同剂量阿托伐他汀对急性ST段抬高型心肌梗死患者血小板反应性的影响  

Impact of Different Atorvastatin Doses on Platelet Reactivity in Patients With Acute ST-elevation Myocardial Infarction

作　　者：徐晓蓉[1] 李奎宝[1] 王攀[1] 刘宇[1] 卢长林[1] 杨新春[1] 杨中甦 

机构地区：[1]首都医科大学附属北京朝阳医院心脏中心,北京市100020

出　　处：《中国循环杂志》2017年第1期26-30,共5页Chinese Circulation Journal

摘　　要：目的:探讨不同剂量阿托伐他汀对急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉(冠脉)介入治疗(PCI)后残余血小板功能和血小板反应性的影响。方法 :行急诊PCI的120例STEMI患者按随机数字表随机分成阿托伐他汀20 mg/d治疗组(标准组,n=60)、阿托伐他汀40 mg/d治疗组(强化组,n=60)。120例患者分别于急诊PCI前及他汀药物治疗后第7天取血,行血脂及生化检测。并通过血栓弹力图测定二磷酸腺苷(ADP)诱导的血小板纤维蛋白凝块强度(MAADP)和花生四烯酸(AA)和ADP诱导的血小板抑制率。结果:经血栓弹力图检测的MAADP值在治疗7天后,强化组较标准组明显下降[(38.40±17.40)mm vs(45.70±14.50)mm,P<0.05],差异有统计学意义。于治疗第7天ADP高反应性的发生率在强化组较标准组明显较少(18.3%vs 31.7%,P<0.05)。AA高反应性的发生率在强化组和标准组无差异(13.3%vs 18.3%,P>0.05)。随访3个月临床终点事件(包括不稳定性心绞痛,非致死性心肌梗死,支架内再狭窄,支架内血栓及心血管疾病死亡或靶血管重建)在两组间差异均无统计学意义(P>0.05)。结论:STEMI患者急诊PCI后早期给予短疗程的高剂量他汀治疗较常规剂量可更显著地抑制血小板活性,降低血小板高反应性。强化治疗3个月临床终点事件未出现显著下降。Objective：To explore the impact of different atorvastatin doses on platelet function and highreactivity in patients with acute ST-elevation myocardial infarction（STEMI） after emergent percutaneouscoronary intervention（PCI） therapy.Methods：A total of 120 STEMI patients with emergent PCI therapy were randomly divided into 2 groups：Standard group,the patients received atorvastatin 20 mg/day and Intensive group,the patientsreceived atorvastatin 40 mg/day,all patients were treated for 7 days.n =60 in each group.Blood lipids and biochemistry were examined before PCI and 7 days after atorvastatin treatment respectively;platelet fibrin clot strength induced by ADP（MAADP）,AA and ADP induced platelet inhibition rate were measured by thrombelastography（TEG） test.Results：With 7 days treatment,compared with Standard group,Intensive group show eddecreased MAADP（38.40±17.40） mm vs（45.70±14.50） mm,P 〈0.05.On day 7 of atorvastatin treatment,compared with Standard group,Intensive group had reduced occurrence rate of high ADP reactivity（18.3% vs 31.7%）,P〉0.05.The occurrence rate of high AA reactivity was similar between 2 groups（13.3% vs 18.3%）,P0.05.The patients were followed-up for 3 months and the end point events including unstable angina,non-fatal MI,in-stent restenosis,in-stent thrombosis,and cardiovascular death or target vessel revascularization were similar between 2 groups,P〉0.05.Conclusion：Early stage and short term administration of high dose atorvastatin could obviously inhibit platelet activity in STEMI patients after emergent PCI;such intensive atorvastatin treatment had no reduction on end point events in 3 months follow-up period.

关 键 词：心肌梗死 降血脂药 血小板 

分 类 号：R541[医药卫生—心血管疾病]