强化他汀治疗ST段抬高型急性心肌梗死患者的疗效及安全性观察

目的探讨ST段抬高型急性心肌梗死(STEMI)患者给予强化他汀治疗的临床应用价值及安全性。方法 STEMI患者60例随机分为2组,均接受常规治疗,强化组30例患者加服阿托伐他汀40 mg/d;对照组30例患者加服阿托伐他汀20 mg/d,所有患者在治疗前及治疗4、12周测定血清超敏C反应蛋白(hs-CRP)、血脂和肌酸激酶(CK)水平,观察2组患者治疗前后肝功能、肾功能等的变化,并通过3个月的随访,观察患者主要心脏不良事件发生情况。结果治疗前2组患者血清hs-CRP、血脂、CK水平比较差异无统计学意义(P>0.05)。治疗后强化组hs-CRP降低的幅度优于对照组,且随着治疗时间的延长持续降低(P<0.01)。2组治疗后hs-CRP、TC、TG、LDL-C、CK均较治疗前降低(P<0.01,P<0.05),HDL-C升高(P<0.05);强化组治疗后hs-CRP、TC、LDL-C降低幅度大于对照组(P<0.01,P<0.05)。强化组主要不良心血管事件发生率为10.7%,对照组为21.9%(P<0.05)。2组间肝肾功能指标、CK及相关不良反应比较差异无统计学意义(P>0.05)。结论较大剂量阿托伐他汀干预治疗可持续降低STEMI患者血清hs-CRP浓度及血脂水平,抑制斑块内炎性反应,并具有良好的安全性。

Efficacy and safety analysis of intensive statin therapy for ST segment elevation acute myocardial infarction patients

Objective To investigate clinical application and safety of intensive statin therapy for ST segment elevation acute myocardial infarction(STEMI) patients.Methods 60 patients with STEMI were randomly divided into two groups. Treatment group was enrolled 30 patients;they were given atorvastatin 40 mg.The control group was enrolled 30 cases;they were received atorvastatin 20 mg.Meanwhile,patients in these two groups underwent conventional treatment.Serum high sensitive C reactive protein(hs-CRP),lipid and creatine kinase(CK) levels were recorded in all patients before treatment,after treatment for 4 weeks,and 12 weeks.Liver function,renal function,index changes in these two groups were observed before and after treatment,and through 3 months of follow-up,major adverse cardiac events were recorded.Results Before treatment, serum hs-CRP,blood lipid levels and creatine kinase did not show statistical significance between the two groups(P>0.05 ).High sensitivity C- reactive protein in the intensive therapy group were lower than the control group(P<0.01),and decreased along with prolong of treatment time.After treatment hs-CRP,TC,TG,LDL-C were significantly lower after treatment than before in both of the two groups(P<0.01,P<0.05),HDL-C increased(P<0.05),but intensive treatment group decreased more significantly,in hs-CRP,TC and LDL-C than those in cortrol group(P<0.01,P<0.05 );Along with the medication time prolonged,TC and LDL-C in the treatment group.The incidence of major adverse cardiac events was 10.7% in treatment group,and 21.9%in control group(P<0.05).Liver and kidney function index,CK and related adverse reaction between the two groups did not show statistical significance(P>0.05).Conclusion Both the two kinds of doses of atorvastatin can play a lipid-lowering effect,high dose atorvastatin sustainable reduced concentrations of serum hs-CRP in patients with STEMI and serum lipid levels,inhibit plaque inflammatory reaction with satisfied safety.