瑞舒伐他汀对急性冠脉综合征患者PCI术后疗效和血清因子表达的影响

目的观察瑞舒伐他汀用于急性冠脉综合征（ACS）经皮冠状动脉介入治疗（PCI）术前及术后对围操作期心肌梗死、血脂水平（TG、TC、LDL-C）、血清炎性因子高敏C反应蛋白（hs-CRP）、白介素18（IL-18）]及脂联素（APN）水平的影响,为找到更适合用于急性冠脉综合征治疗的他汀类药物提供依据。方法采用前瞻性、双盲、随机对照研究方法,180例行PCI术的急性冠脉综合征患者,随机分为实验1组（术前口服安慰剂,术后瑞舒伐他汀10mg/d口服24周）、实验2组（术前口服瑞舒伐他汀40mg、术后10mg/d口服24周）、实验3组（术前口服瑞舒伐他汀40mg、术后20mg/d口服24周）、实验4组（术前口服阿托伐他汀80mg,术后20mg/d口服24周）,每组均为45例。观察PCI围操作期心肌梗死的发生情况在各组间的差别;观察术前及术后多个时点的血脂水平及APN、hs-CRP、IL-18的表达在各组间的差别。结果实验2组、3组、4组的围操作期心肌梗死少于实验1组（P〈0.05）。在术后4、12、24周,1～3组降低TC、LDL-C的效果好于4组,其中3组效果最佳。hs-CRP及IL-18水平在术后48h时2、3、4组均低于1组,其中3组最低;在术后4、12、24周时1、2、3组均低于4组,仍为3组最低。脂联素在术后4~24周逐渐升高,升高幅度由高到低的排序为：3组、2组和1组、4组。结论 PCI术前服瑞舒伐他汀能减少急性冠脉综合征行PCI术患者的围操作期心肌梗死;瑞舒伐他汀具有比等效剂量的阿托伐他汀更好的降脂、降低急性冠脉综合征患者血清hs-CRP、IL18及升高APN的作用,从而具有更好的抗炎、抗动脉粥样硬化的作用;临床应用20mg/d瑞舒伐他汀比10mg/d具有更好的效果。

The curative effect after PCI and impact on serum cytokines of Rosuvas- tatin in the therapy of acute coronary syndrome

Objective To investigate the effect of Rosuvastatin on patients with acute coronary syndrome （ACS） who ac- cepted pereutaneous coronary intervention（PCI）. In these cases, blood lipid level and serum concentration of high sensi- tivity C reactive protein（hs-CRP）, Intedeukin 18（IL-18） and adiponectin（APN） were examined, as well as the morbidity of perioperative myocardial infarction. The impact of Rosuvastatin on the concentrations and morbidity above were evalu- ated in order to discover the better statin for ACS. Methods Prospective, double blind and randomized controlled trial was processed in 180 ACS patients who were prepared for PCI. These patients were divided into 4 groups： group I（G1, placebo for preoperation and Rosuvastatin 10 mg for 24 weeks for postoperation）, group 2 （G2, Rosuvastatin 40 mg for pre and 10 mg for post）, group 3（G3, 40 mg Rosuvastatin for pre and 20 mg for post） and group 4（G4, atorvastatin 80 mg for pre and 20 mg for post）. There were 45 patients in each group. Perioperative myocardial infarction morbidity, blood lipid and serum factor concentrations above were examined in designed time points as to find the difference between each group. Results Infarction morbidity in G2, G3 and G4 were less than Gl（P 〈 0.05）. On 4th,12th and 24th week, TC and LDL-C lowering effects in group 1-3 were better than that of G4. G3 had the most significant lowering effect. The levels of hs-CRP and IL-18 in group 1-3 were lower than that of G4,among which G3 had the lowest concentration. Concentration of APN rose from 4th-24th week,order from most to least： G3, G2 and 1,G4. Conclusion Preoperation Ro- suvastatin can reduce perioperative myocardial infarction in ACS patients for PCI. Rosuvastatin does a better job in lipid lowering and reduction of hs-CRP and IL-18, as well as development of APN. Rosuvastatin does a better job forantiinflammation and antiatherosclerosis than atorvas tatin. Rosuvastatin 20 mg/d did a better job than 10 mg/d.