负荷量阿托伐他汀对不稳定型心绞痛患者冠状动脉介入治疗后近期心血管事件的影响

目的观察负荷量阿托伐他汀对不稳定型心绞痛(unstable angina,UA)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后近期心肌损伤、心肌灌注和心血管事件的影响。方法选取2009年11月至2011年10月在江门市五邑中医院行PCI治疗的UA患者56例,按电脑随机数字表法分为治疗组28例和对照组28例。治疗组在术前7 d给予负荷量阿托伐他汀40 mg/d,术后两组均给予阿托伐他汀10 mg/d治疗。分别于术前,术后24 h、3 d检测血清心肌型肌酸激酶同工酶(MB isoenzyme of creatine kinase,CK-MB)、血肌钙蛋白(troponin I,TnI)、一氧化氮(nitric oxide,NO)浓度;术前、术后即刻评估TMI心肌灌注分级(TMImyocardial perfusion,TMP)情况,并记录术后随访3个月的主要心血管事件。结果两组术后24 h血CK-MB、TnI浓度明显升高,术后3 d较前有所下降;治疗组血清CK-MB、TnI浓度均低于对照组,差异均有统计学意义(P=0.037,P=0.046);两组术后NO水平明显升高,以治疗组升高更为显著,差异有统计学意义(P=0.049);PCI治疗前、后治疗组TMP 0/1级的发生率低于同期对照组,差异均有统计学意义(P=0.017,P=0.019);术后随访3个月,治疗组心血管事件发生率10.7%低于对照组21.4%,治疗组整体发生主要心血管事件的病情程度轻于对照组,差异均有统计学意义(P<0.05)。结论 PCI治疗前给予负荷量阿托伐他汀能改善UA患者术后心肌血流灌注,减少心肌损伤,可能降低术后3个月内心血管事件发生率及减轻病情严重程度,从而改善患者的预后。

Effects of atorvastatin loading on recent cardiovascular events in patients with unstable angina after percutaneous coronary intervention

Objectives To observe the effects of atorvastatin loading on recent myocardial injury, myocardial perfusion and cardiovascular events in patients with unstable angina （UA） after percutaneous coronary intervention （PCI）. Methods Totally 56 patients with UA undergoing PCI in Wuyi Traditional Chinese Medicine Hospital of Jiangmen from November 2009 to October 2011 were randomly divided into treatment group （n=28） and control group （n=28）. Treatment group were given a 40 mg/d loading dose of atorvastatin in seven days preoperative. After PCI, two groups were both given atorvastatin 10 mg/d. Levels of serum MB isoenzyme of creatine kinase （CK-MB）, troponin 1 （TnI） and nitric oxide （NO） were measured before PCI, 24 h and 3 d after PCI. TMI myocardial perfusion （TMP） was assessed before PCI and immediately postoperatively. Major adverse cardiovascular events （MACE） were recorded in 3 months after PCI. Results CK-MB and TnI levels improved significantly 24 h after PCI, declined 3 d after PCI in the two groups ; levels of CK-MB and TnI in treatment group were significantly lower than those in control group （P= 0.037, P=0.046）. NO levels of the two groups improved significantly after operation, and treatment group increased more significantly （P=0.049）. Incidence of TMP 0/1 level in treatment group was significantly lower than that in control group before and after PCI （P=0.017, P=0.019）. After 3 months＇ follow-up, MACE of treatment group was 10.7% and was significantly lower than that of control group （21.4%）. Severity of cardiovascular disease in treatment group was significantly lighter than that in control group （P〈0.05）. Conclusions Atorvastatin loading given before PCI can improve UA patients＇ postoperative myocardial perfusion, reduce myocardial injury, reduce the incidence of MACE in 3 months after surgery and the severity of disease, thus lead to improvement of patients＇ prognosis.