瑞舒伐他汀对急性STEMI冠脉介入治疗后存活心肌功能及动脉粥样硬化的影响

目的：探讨瑞舒伐他汀作为新型他汀类药物对急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗（PCI）后存活心肌功能及动脉粥样硬化的影响。方法：65例STEMI患者被随机分为辛伐他汀组（32例）和瑞舒伐他汀组（10mg，睡前服，33例），随访12个月，测定患者在介入前、后12个月的血脂及血浆C-反应蛋白（CRP）、肿瘤坏死因子-a（TNF-a）水平，并观察颈动脉内膜中层厚度（IMT）及99m锝-甲氧基异丁基异腈（99mTc—MIBI）摄取分数的改变。结果：两组患者治疗12个月后，总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、CRP及TNF-a水平均有显著下降（P〈0．05～〈0．01），而99mTc—MIBI摄取分数均显著增加；且与辛伐他汀组比较，瑞舒伐他汀组治疗后TC（4．54±0．66）mmol／L比（3．21±0．53）mmol／L]、LDL-C（2．71±0．53）mmol／L比（2．01±0．34）mmol／L]、CRP（0．41±0．15）mg／ml比（0．28±0．13）mg／ml]、TNF—a（1．48±1．15）ng／ml比（1．05±0．91）ng／ml]水平明显降低及99mTc-MIBI摄取分数（1．66±0．38）比（1.99±0．46）]明显增加（P〈0．05）。瑞舒伐他汀组患者治疗后IMT较治疗前明显减小（0．81±0．27）mm比（0．98±0．41）mm，P〈0．01]，且优于辛伐他汀组（0．81±0．27）mm比（0．93±0．33）mm]，而辛伐他汀组IMT无明显变化（P〉0．05）。结论：在PCI术及常规药物基础上加用瑞舒伐他汀可使急性ST段抬高型心肌梗死患者颈动脉内膜中层厚度明显减小，并进一步改善存活心肌细胞功能。

Influence of rosuvastatin on function of survival myocardium and arteriosclerosis in acute STEMI patients after PCI

Objective:To study influence of rosuvastatin on function of survival myocardium and arteriosclerosis in patients with acute ST segment elevation myocardial infarction(STEMI) after percutaneous coronary intervention(PCI).Methods:A total of 65 STEMI patients were randomly divided into simvastatin group(n=32) and rosuvastatin group(n=33,received rosuvastatin 10mg/d before sleep).All patients were followed up for 12 months.Levels of blood lipids,plasma C reactive protein(CRP) and tumor necrosis factor-α(TNF-α) were measured in all patients before and 12 months after PCI.Changes of carotid intima-media thickness(IMT) and intake fraction of 99mTc-methoxy isobutyl isonitrile(99mTc-MIBI) were observed in two groups.Results:After 12-month treatment,there were significant decrease in levels of total cholesterol(TC),low density lipoprotein-cholesterol(LDL-C),CRP and TNF-α(P<0.05～<0.01),and significant increase in intake fraction of 99mTc-MIBI in both groups;compared with simvastatin group,there were significant decrease in levels of TC (4.54±0.66) mmol/L vs.(3.21±0.53) mmol/L],LDL-C (2.71±0.53) mmol/L vs.(2.01±0.34) mmol/L],CRP (0.41±0.15) mg/ml vs.(0.28±0.13) mg/ml] and TNF-α (1.48±1.15) ng/ml vs.(1.05±0.91) ng/ml],and significant increase in intake fraction of 99mTc-MIBI (1.66±0.38) vs.(1.99±0.46)] in rosuvastatin group after treatment,P<0.05 all.Compared with before treatment,there was significant decrease in IMT (0.98±0.41) mm vs.(0.81±0.27) mm,P<0.01],and was significantly lower than that of simvastatin group(0.81±0.27) mm vs.(0.93±0.33) mm] in rosuvastatin group after treatment.Conclusion:Rosuvastatin therapy based on routine drug and percutaneous coronary intervention can significantly decrease intima-media thickness and further improve cellular function of survival myocardium in patients with acute ST segment elevation myocardial infarction.