STEMI患者急诊PCI前口服阿托伐他汀对炎症介质及左心室功能的影响

目的 探讨急性ST段抬高性心肌梗死（STEMI）患者在接受急诊经皮冠状动脉介入手术（PCI）前口服阿托伐他汀40mg，对外周静脉和梗死相关冠状动脉(ICA）中的炎症介质水平与左心室功能的影响。方法  选取接受急诊PCI的STEMI患者60例，随机分为治疗组（PCI术前口服阿托伐他汀40mg, n=32）和对照组（n=28）。两组分别于PCI术前即刻、术后24h抽取外周静脉血和术中抽取ICA血，测定并比较白细胞介素-6（IL-6)、基质金属蛋白酶-9（MMP-9)和可溶性CD40配体（sCD40L）的浓度；PCI术后1周常规行超声心动图检查，测定左心室舒张末期容积（EDV-LV）、左心室收缩末期容积（ESV-LV）、左心室射血分数(LVEF)、左心室峰值射血率(PER-LV)、左心室峰值充盈率(PFR-LV)。结果 组间对比，PCI术前，治疗组外周静脉中IL-6的浓度显著低于对照组；PCI术后24h，治疗组外周静脉血中的IL-6、sCD40L和MMP-9浓度显著低于对照组。AMI后第7天，治疗组的EDV-LV、ESV-LV、LVEF、PER-LV、PFR-LV较对照组无显著变化；组内对比，在两组患者中，PCI术前ICA中的IL-6、sCD40L和MMP-9浓度均显著高于其外周静脉水平。术后24h，所有患者外周静脉血IL-6和MMP-9的浓度均显著增高（P均<0.05），而sCD40L的浓度只有对照组明显升高（P均<0.05）。结论 STEMI发生时，ICA中的MMP-9、IL-6和sCD40L的水平显著高于外周静脉，而患者于急诊PCI术前口服阿托伐他汀能够不同程度降低炎症介质的水平，但对近期左心室功能无明显改善。

Effects of atorvastatin given before acute PCI on inflammatory mediators and left ventricular function in STEMI

Objective To explore the effects of atorvastatin administered to AMI patients before acute PCI on levels of inflammatory markers in systemic circulation or within ICA and left ventricular function 7 days after AMI.Methods 60 patients with STEMI who had undergone acute PCI were enrolled in this study.All patients were randomly assigned into the atorvastatin group(group A) and the control group(group B).Group A consisted of 32 patients who took 40 mg atorvastatin while group B consisted of 28 patients who too...