冠状动脉介入围术期强化阿托伐他汀干预的临床效果分析  

Clinical benefits of intensified atorvastatin intervention perioperative coronary intervention therapy

作　　者：周妙 贾海蓉 肖鑫润 周建军 ZHOU Miao;JIA Hairong;XIAO Xinrun;ZHOU Jianjun(Department of Cardiovascular,Yiyang Central Hospital,Hunan University of Traditional Chinese Medicine,Yiyang 413000,China)

机构地区：[1]湖南中医药大学附属益阳市中心医院心血管内科,413000

出　　处：《心肺血管病杂志》2024年第10期1039-1044,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：益阳市科技计划项目([2022]108号)。

摘　　要：目的:为了探讨在急性冠状动脉综合征(acute coronary syndrome,ACS)患者PCI围术期强化阿托伐他汀干预对ACS患者血清活化转录因子4(activated transcription factor 4,ATF-4)、C/EBP同源蛋白(C/EBP homologous protein,CHOP)水平的影响。方法:选取2021年10月至2023年6月在益阳市中心医院行择期PCI术的老年ACS患者168例,随机分成研究组和对照组,每组各84例。分别于治疗前、术后24h、术后48h、术后72h检测患者血清ATF-4、CHOP蛋白SCr、胱抑素C(Cystatin C,Cys C)水平;于治疗前和术后24h内检测CK-MB、cTnI水平,随访术后72h内ACS患者造影剂诱导急性肾损伤(contrast-induced acute renal injury,CI-AKI)情况,并比较CI-AKI组和非CI-AKI组血清ATF-4、CHOP蛋白水平差异。结果:在术后24h、术后48 h和术后72 h时,研究组血清ATF-4、CHOP蛋白水平均明显低于对照组(均P<0.05);术后24h时,研究组血清CK-MB、cTnI峰值均明显低于对照组(均P<0.05);在术后48h和72h时,研究组SCr和Cys-C水平均明显低于对照组(均P<0.05)。在使用对比剂72h内对照组与研究组CI-AKI发生率分别为16例(19.1%)和4例(4.8%),研究组患者CI-AKI发生率低于对照组(χ^(2)=8.173,P=0.004);在术后24h、术后48 h和术后72 h时,CI-AKI组ATF-4、CHOP蛋白水平均高于非CI-AKI组(均P<0.05)。并且CIAKI组患者术后72h内,血清ATF-4水平和CHOP水平一直呈上升趋势,而在术后72h时,非CIAKI组患者血清ATF-4水平较术后48h时有回落趋势。结论:ATF-4/CHOP是CI-AKI发生的重要分子机制,在PCI术前对ACS患者给予负荷剂量阿托伐他汀有助于降低血清ATF-4、CHOP水平,改善心功能和肾损伤,降低CI-AKI的发生率。Objective:In order to explore the effect of intensive atorvastatin intervention prior to elective PCI on serum activated transcription factor 4(ATF-4)and C/EBP homologous protein(CHOP)levels in patients with acute coronary syndrome(ACS).Methods:A total of 168 elderly ACS patients who underwent elective PCI in our hospital from October 2021 to June 2023,and divided them into a study group and a control group according to a computer random sequence,with 84 cases in each group.The levels of serum ATF-4,CHOP,SCr and Cystatin C(Cys c)were measured before treatment,24 h,48 h and 72 h after PCI.And the levels of CK-MB and cTnI were measured before treatment and during 24 hours after PCI.Patients with contrast-induced acute renal injury(CI-AKI)were recorded within 72 hours after PCI,and the serum levels of ATF-4 and CHOP in CI-AKI Group and non-CI-AKI Group were compared.Results:At 24h,48h,and 72h after PCI,the serum ATF-4 and CHOP protein levels in the study group were significantly lower than those in the control group(all P<0.05).At 24 hours after operation,the serum CK-MB and cTnI peaks of the study group were significantly lower than those of the control group(all P<0.05).At 48h and 72h after operation,the levels of SCr and Cys-C in the study group were significantly lower than those in the control group(all P<0.05).The incidence of CI-AKI in the control group and the study group within 72 hours after the contrast agent was 16 cases(19.1%)and 4 cases(4.8%),respectively.The incidence of CI-AKI in the control group was lower than that in the study group(χ^(2)=8.173,P=0.025).At 24h,48h,and 72h after surgery,the levels of ATF-4 and CHOP proteins in the CI-AKI group were higher than those in the non-CI-AKI group(all P<0.05).In the CI-AKI group,serum ATF-4 levels and CHOP levels had a trend of increasing within 72h after PCI.But at 72h after PCI,the serum ATF-4 level of patients in the non-CI-AKI group tended to decrease compared with that at 48 hours after PCI.Conclusions:ATF-4/CHOP would be an important molecular mecha

关 键 词：急性冠状动脉综合征 经皮冠状动脉介入术 阿托伐他汀 负荷剂量 活化转录因子4 C/EBP同源蛋白 造影剂引起的肾损伤 

分 类 号：R54[医药卫生—心血管疾病]