老年急性心肌梗死PCI术无复流患者强化阿托伐他汀治疗临床分析

目的观察强化阿托伐他汀治疗老年急性ST段抬高型心肌梗死(STEAMI)急诊行经皮冠状动脉介入治疗(PCI)并出现无复流患者血管内皮的保护作用及安全性。方法选择2009年12月至2013年1月在河北大学附属医院心内科住院行急诊PCI并发生无复流的老年STEAMI患者48例,随机分为对照组及治疗组,每组各24例。治疗组患者口服阿托伐他汀80 mg 1/日,对照组给予阿托伐他汀20 mg口服。连续治疗10 d。比较两组患者治疗前后血脂、Ⅲ型前胶原N端肽(PⅢNP)、基质金属蛋白酶-9(MMP-9)、血管性血友病因子(v WF)的水平及不良反应。结果与治疗前比较,对照组和治疗组连续治疗10 d后,总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)均下降,差异具有统计学意义(P均0.05);v WF下降,差异具有显著统计学意义(P均0.01)。与对照组治疗后比较,治疗组治疗后LDL-C[(3.41±0.43)mmol/L vs.(2.14±0.38)mmol/L]、MMP-9[(150.31±12.18)ng/m L vs.(115.41±13.62)ng/m L]、v WF[(76.9±7.03)%vs.(48.31±6.9)%]水平下降(P均0.05),PⅢNP[(114.71±13.23)ng/m L vs.(64.26±11.43)ng/m L]下降,差异具有显著统计学意义(P均0.01)。两组治疗后心肌酶水平较治疗前均下降,差异具有统计学意义(P均0.05)。治疗组有3例患者出现胃肠功能紊乱症状;对照组没有患者出现腹胀、消化不良等症状。结论急诊PCI治疗出现无复流老年患者强化阿托伐他汀治疗可明显改善患者血脂、PⅢNP、MMP-9、v WF的水平,保护血管内皮并抑制炎症反应。

Curative effect of intensive atorvastatin therapy on no-reflow during percutaneous coronary intervention in elderly patients with acute myocardial infarction

Objective To observe the vascular endothelial protective effect and safety of intensive atorvastatin therapy in treatment of no-reflow （NR） during emergency percutaneous coronary intervention （PCI） in elderly patients with ST-segment elevation acute myocardial infarction （STEAMI）.Methods The patients （n=48） were chosen from Dec. 2009 to Jan. 2013, and randomly divided into control group and treatment group （eachn=24）. The treatment group was given atorvastatin （80 mg） and control group was given atorvastatin （20 mg） once a day for 10 d. The levels of blood fat, procollagen Ⅲ N-terminal peptide （PⅢNP）, matrix metalloproteinase-9 （MMP-9） and von Willebrand factor （vWF）, and adverse reactions were compared between 2 groups before and after treatment. Results The levels of total cholesterol （TC）, low-density lipoprotein-cholesterol （LDL-C） and vWF decreased in 2 groups after 10-d treatment （allP〈0.05）. After treatment and compared with control group, in treatment group the levels of LDL-C [（3.41±0.43） mmol/Lvs. （2.14±0.38） mmol/L], MMP-9 [（150.31±12.18） ng/mLvs. （115.41± 13.62） ng/mL] and vWF [（76.9±7.03）%vs. （48.31±6.9）%] decreased （allP〈0.05）, and PⅢNP [（114.71±13.23） ng/mLvs. （64.26±11.43） ng/mL] decreased （allP〈0.05）. The level of myocardial enzyme decreased in 2 groups than before （allP〈0.05）. There were 3 cases with symptoms of gastrointestinal disorders and there was no case with symptoms of abnormal distension and dyspepsia.Conclusion Intensive atorvastatin therapy can significantly ameliorate the levels of blood fat, PⅢNP, MMP-9 and vWF, protect vascular endothelium and inhibit inflammatory reaction in elderly patients with NR during emergency PCI.