强化调脂治疗对经皮冠状动脉干预术后患者C反应蛋白的影响

目的　探讨阿托伐他汀 2 0mg/d对经皮冠状动脉干预 (percutaneouscoronaryintervention ,PCI)术后患者外周血C反应蛋白 (C reactiveprotein ,CRP)的降低能力是否强于 10mg/d。方法　连续选择因狭窄性病变行PCI的不稳定性心绞痛患者 4 8例 ,随机分为强化调脂组和常规调脂组 ,术后分别给予阿托伐他汀 2 0mg和 10mg,1次 /d。术前、术后 3d、3个月测定外周静脉血CRP、血脂等。结果　与术前比较 ,3个月后强化调脂组总胆固醇和低密度脂蛋白分别下降 2 1.6 %和 39.3% ,常规调脂组下降 11.6 %和 14 .8% ,阿托伐他汀 2 0mg/d降低总胆固醇和低密度脂蛋白的能力强于 10mg/d。强化调脂组术前 ,术后 3个月CRP中位数分别为 4 .1和 1.1mg/L ;常规调脂组为 7.1和 1.4mg/L。两组CRP的降低程度差异有显著性意义。阿托伐他汀的抗炎作用和术前的CRP水平相关 ,3个月后CRP的下降程度与血脂改变无相关性。结论　阿托伐他汀 2 0mg/d较 10mg/d能使PCI术后CRP进一步下降。

Effect of aggressive lipid-lowering therapy on C-reactive protein after percutaneous coronary intervention

Objective To explore whether aggressive lipid-lowering therapy with atorvastatin 20 mg daily was more effective than conventional statin treatment(atorvastatin 10 mg daily) in the lowering of C-reactive protein(CRP) in patients undergoing PCI.Methods The study population consisted of 48 consecutive patients with unstable angina who underwent elected PCI for stenotic lesions of the coronary artery.Patients were randomly assigned to either aggressive group or conventional one.Fasting peripheral venous blood samples were obtained to determine CRP and lipid profile at baseline,3 days and 3 months after PCI.Results Compared with baseline,the total cholesterol and LDL-cholesterol in aggressive group 3 months after PCI decreased by 21.6% and 39.3%,while by 11.6% and 14.8% in conventional group.Atorvastatin 20 mg daily showed greater reduction in concentrations of total cholesterol and LDL cholesterol than conventional therapy.Preoperative median CRP value was 4.1mg/L and after 3 months the value decreased to 1.1 mg/L in 20 mg group,while these values were 7.1 mg/L and 1.4 mg/L in 10 mg group,respectively.The change of CRP after 3 months was different significantly between the two groups.The anti-inflammatory effect of atorvastatin was positively related with preoperative level of CRP.No correlation was observed between change in CRP and lipids after 3 months.Conclusion Atorvastatin 20 mg reduces CRP level to a greater extent than atorvastatin 10 mg daily does.