阿托伐他汀序贯治疗对急性ST段抬高型心肌梗死直接PCI治疗患者血清IL-6和hs-CRP的影响

目的 探讨经皮冠状动脉介入治疗(PCI)围手术期阿托伐他汀序贯治疗对急性ST段抬高型心肌梗死(STEMI)患者血清白细胞介素-6(IL-6)和高敏C反应蛋白(hs-CRP)浓度的影响. 方法 76例接受急诊PCI的STEMI患者随机分为A组(n=26)、B组(n=26)和C组(n=24).A组给予阿托伐他汀钙20 mg,1次/d;B组给予阿托伐他汀钙80 mg PCI术前30 min顿服,术后20 mg,1次／d;C组术前同B组,术后给予阿托伐他汀钙40 mg,1次／d.于术前即刻及术后l,3,7d测定血清肌酸激酶同工酶(CK-MB)、肌钙蛋白T(cTnT)、IL-6和hs-CRP水平. 结果 术前三组间患者血清CK-MB、cTnT、IL-6和hs-CRP水平无统计学差异(P＞0.05),术后1d均较术前增高(P＜0.05).PCI治疗后3d,CK-MB、cTnT和IL-6水平开始下降,血清hs-CRP水平仍呈升高趋势(P＜0.05).PCI治疗后7d,各组CK-MB、cTnT较术前均有下降(P＜0.05),IL-6和hs-CRP较术后3d明显下降(P＜0.05),B组和C组血清CK-MB、cTnT、IL-6和hs-CRP水平较A组下降明显(P＜0.05),且C组较B组更为明显(P＜0.05). 结论 STEMI患者PCI围术期使用大剂量阿托伐他汀序贯治疗短期即可显著降低血清炎性因子,减少心肌损伤.

Effects of sequential therapy of atorvastatin on serum IL-6 and hs-CRP levels in patients undergoing percutaneous coronary intervention for acute ST-segment elevation myocardial infarction

Objective To explore the effects of sequential therapy of atorvastatin on concentrations of serum interleukin-6(IL-6)and high sensitivity C-reactive protein(hs-CRP)in patients undergoing percutaneous coronary intervention(PCI)for acute ST-segment elevation myocardial infarction(STEMI).Methods Totally 76 STEMI patients who underwent emergent PCI were randomly divided into group A(n=26),group B(n=26)and group C(n=24).Patients were administered with 20 mg atorvastatin once a day in group A,80 mg atorvastatin 30 min before PCI and 20 mg atorvastatin once a day after PCI in group B,and 80 mg atorvastatin 30 min before PCI and 40 mg atorvastatin once a day after PCI in group C.Serum creatine kinase-MB(CK-MB),cardiac troponin T(cTnT),IL-6 and hs-CRP levels were determined immediately before operation,1 d,3 d and 7 d after operation.Results Serum CK-MB,cTnT,IL-6 and hs-CRP levels were not significantly different before operation among three groups(P>0.05).Serum CK-MB,cTnT,IL-6 and hs-CRP levels were significantly increased 1 d after operation in three groups(P<0.05).Serum CK-MB,cTnT and IL-6 began to decrease 3 d after operation,however,the level of serum hs-CRP still showed a increasing tendency(P<0.05).At 7 d after PCI treatment,CK-MB and cTnT levels were significantly lower than those before operation in three groups(P<0.05),and IL-6 and hs-CRP levels were also significantly lower than those at 3 d after operation(P<0.05).Levels of serum CK-MB,cTnT,IL-6 and hs-CRP in group B and group C were significantly lower than those in group A(P<0.05),and those in group C were also lower than in group B(P<0.05).Conclusion Administration of large dose of atorvastatin as sequential therapy for STEMI before and after PCI can have a short-term effect by significantly decreasing the serum inflammatory factors and reducing the myocardial injury.