不同剂量阿托泛他汀对经皮冠状动脉介入治疗术患者黏附分子的影响

探讨不同剂量阿托泛他汀对经皮冠状动脉介入治疗（percutaneous coronary intervention，PCI）患者外周血可溶性细胞间黏附分子-1（soluble intercellular adhesio nmolecule-1，sICAM-1）的影响。方法：选择因冠脉狭窄病变需行PCI的不稳定心绞痛30例，陈旧性心肌梗死10例，随机分为强化调脂组和常规调脂组，术后分别给予阿托伐他汀20mg／d和10mg／d；测定术前，术后3个月血脂（TC，TG，LDL—C，HDL—C）以及术前，术后48h，术后3个月sICAM-1的变化。结果：术后3个月两组TC和LDL—C显著下降（P〈0．01），且强化调脂组较常规调脂组下降更显著（P〈0．01），而HDL—C和TG改变不显著（P〉0.05）；术后48h，两组sICAM-1均较术前显著升高（P〈0．01），而术后3月两组sICAM-1均较术前显著下降（P〈0．01，或P〈0．05），且强化调脂组较常规调脂组下降更显著（P〈0．01）；TC与sICAM-1呈正相关，（r=0．2413，P〈0．05），LDL—C与sICAM-1也呈正相关（r=0．2691，P〈0．05）。结论：强化调脂治疗比常规调脂治疗更能显著降低PCI患者术后TC，LDL—C和sICAM-1水平，其降低sICAM-1水平可能与降脂治疗有一定关系。

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OBJECTIVE: To determine the effect of different doses of atorvastatin on the serum soluble intercellular adhesion molecules-1 (sICAM-1) in patients undergoing percutaneous coronary intervention (PCI). METHODS: The study consisted of 38 patients with unstable angina and 10 patients with old inarction who underwent elected PCI for stenotic lesions of the coronary artery. Patients were randomly assigned to either aggressive group or conventional one. After PCI the patients took atorvastatin 20 mg per day or 10 mg per day. Blood lipid profile was examined before, and 3 months after the PCI. SICAM-1 was examined before the PCI, 48 hours and 3 months after the PCI. RESULTS: The total cholesterol and LDL-Cholesterol 3 months after the PCI in the 2 groups were lower than those before the PCI (P<0.01). The aggressive group showed greater reduction in concentrations of TC and LDL-C than the conventional group (P<0.01). The changes in concentrations of HDL-C between pre-PCI and 3 months after the PCI and TG were not obvious (P>0.05). sICAM-1 in the 2 groups 48 hours after the PCI significantly higher than that before the PCI (P<0.01). But sICAM-1 in the 2 groups 3 months after the PCI significantly lower than that before the PCI (P<0.01 or P<0.05). The aggressive group showed greater reduction than the conventional group (P<0.01). TC and LDL-C were positively correlated with sICAM-1(r=0.2413, r=0.2691, all P<0.05). CONCLUSION: Atorvastatin 20 mg per day reduces TC, LDL-C, and sICAM-1 to a greater extent than atorvastatin 10 mg per day. The effect on sICAM-1 is partly related to reduce lipid profile.