辛伐他汀预处理对择期PCI术围术期心肌损伤的影响

目的 了解冠心病患者经皮冠状动脉内介入治疗（PCI）围术期心肌损伤标记物的变化，探讨他汀类药物预处理是否能够减弱围术期心肌的急性损伤。方法 选择具有典型稳定型心绞痛症状或负荷试验阳性患者101例，采用随机、对照、单盲的方法将病人分为两组：对照组49例给予安慰剂治疗，他汀组52例给予辛伐他汀片20mg，每晚睡前服用。所有病人入选后按分组开始治疗，治疗7d后行PCI治疗，术前、术后8h、术后24h分别检测肌酸激酶（CK）、肌酸激酶同工酶（CK—MB）和肌钙蛋白Ⅰ（cTnⅠ）。结果 两组PCI术前CK、CK-MB和cTnI比较差异无统计学意义，P〉0．05；两组术后8h与术前比较，CK、CK-MB和cTnI明显升高，P〈0．05，术后24h进一步升高，P〈0．01；术后8h及24h，常规组CK、CK-MB和cTnI均较他汀组升高明显，P〈0．05。结论 PCI围术期存在心肌的急性损伤，辛伐他汀预处理具有明显改善围术期心肌急性损伤的作用。

Effect of pretreatment percutaneous coronary with simvastatin on endothelial function and myocardial damage during elective intervention

Objective To know the changes of myocardial damage markers during elective percutaneous coronary intervention(PCI)and to investigate whether to weaken the changes with simvastatin therapy before PCI.Methods One hundred and One patients with chronic stable angina without previous statin treatment were enrolled in the study.Patients scheduled for elective coronary intervention were randomized to simvastatin(20mg/d,n=52)or placebo(n=49) 7 days before the procedure.Creatine kinase(CK),creatine(kinase-)MB(CK-MB),and troponin I(TnI) levels were measured at baseline,8 and 24 hours after the procedure.Results After pretreatment,the serum levels of CK,CK-MB and cTnI were similar between various groups before PCI,P>0.05;At 8 hours,CK,CK-MB and cTnI levels of two groups were more significantly increased than at baseline,P< 0.05;At 24 hours,these variations become more significant,P<0.01;Moreover,increases of CK,CK-MB and cTnI were more notable in the placebo group at 8 and 24 hours compared with the statin group,P<0.05. Conclusion During PCI myocardium were damaged.Pretreatment with simvastatin 20 mg/d for 7 days can significantly reduce periprocedural myocardial injury in elective PCI.