强化阿托伐他汀治疗对急性冠脉综合征患者PCI围手术期炎症反应和心肌损伤的影响

目的观察强化阿托伐他汀治疗对急性冠脉综合征（ACS）患者PCI围手术期炎症反应和心肌损伤的影响。方法将本院心内科2011年10月-2012年4月收治的ACS患者130例随机分为两组：强化治疗组65例于PCI术前2小时给予阿托伐他汀40mg口服,术后1个月内继续强化他汀治疗40mg/d,1个月后改为维持剂量20mg/d。标准治疗组65例PCI术前及术后均给予阿托伐他汀20mg/d,晚饭后顿服。随访30天,所有患者于PCI术前、术后24小时测定肌钙蛋白（IcTnI）、肌酸激酶同工酶（CK-MB）水平;PCI术前及术后1、7、30天测定血清C反应蛋白（CRP）、谷丙转氨酶（ALT）、肌酸激酶（CK）水平,PCI术前及术后7、30天测定总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）水平,观察并比较两组患者PCI术后30天内心脏不良事件与药物不良反应的发生情况。结果 PCI术后24小时两组患者cTnI、CK-MB水平均较术前有明显增高（P〈0.05）,但强化治疗组CK-MB、cTnI水平低于标准治疗组（P〈0.05）。术后第1天两组患者血中CRP均较术前显著升高（P〈0.05）,组间比较差异无统计学意义（P〉0.05）;术后第7天强化治疗组血中CRP水平下降至术前水平（P〉0.05）,标准治疗组中虽下降,但仍高于术前水平（P〈0.05）,组间比较差异有统计学意义（P〈0.05）;术后30天强化治疗组患者血中CRP水平明显低于术前（P〈0.05）,而标准治疗组CRP水平与术前比较无明显差异（P〉0.05）。两组患者用药前血脂无明显差异,用药后血脂均有所下降,且各时间点组间比较均无统计学意义（P〉0.05）。随访30天,两组患者均无1例心血管不良事件发生。两组药物不良反应发生率分别为6.15%、4.62%,无统计学差异（P〉0.05）。结论强化阿托伐他汀治疗可减少ACS患者PCI围手术期炎症反应和心肌损伤,值得临床推广应用。

Effect of Enhanced Atorvastatin Therapy on Perioperative Inflammatory Response and Myocardial Injury of PCI in Patients with ACS

Objective To observe the effect of enhanced atorvastatin therapy on perioperative inflammatory response an myocardi- al injury of percutaneous coronary intervention （PCI） in patients with acute coronary syndrome （ACS）. Methods 130 patients with ACS hospitalized from Oct., 2011 to April, 2012 were randomly divided into 2 groups： enhanced group and routine group, 65 cases in each; for patients in enhanced group, oral administration of 40mg of atorvastatin was made 2 hours before PCI and that of 40mg a day kept for 1 month after PCI and then the dosage changed to 20mg a day; for patients in routine group, oral administration of 20mg was made before and after PCI, everyday after supper; follow-up lasted for 30 days; of all the patients in both groups, the level of cTnI and CK-MB before and 24 hours after PCI, that of CRP, ALT and CK before and 1 day, 7 days and 30days after PCI, as well that of TC, LDL-C before and 7 days and 30 days after PCI were detected; observation and a contrast study on adverse cardiac event and drug side-effect were made between the 2 groups. Results The level of cTnI and CK-MB 24 hours after PCI in all the patients in both groups were much higher than those before PCI （P 〈0.05）while the increase in enhanced group was smaller than that in routine group （P〈0.05）; one day after PCI, CRP of all the patients in both groups increased obviously, much higher than those before PCI while the difference between the 2 groups was of no statistical significance （P〉0.05）; 7 days after PCI, CRP of the patients in enhanced group dropped down to the level before PCI while that of the patients in routine group dropped down as well, but it was still higher than the level before PCI （P〉0.05）, the difference between the 2 groups was of statistical significance （P〈0.05）; 30 days after PCI, the level of CRP of the patients in enhanced group was obviously lower than that before PCI （P 〈0.05） while the level of CRP of the patients in rou- tine group was of no obvious difference from that before PCI （P 〉0.05）; blood lipid of the patients in both groups dropped down after drug administration though there was no obvious difference between them before, and the comparison of each time points between the 2 groups had no statistical significance （P〉0.05）; follow-up for 30 days found no occurrence of adverse cardiac event; the occurrence of drug side-effect of the 2 groups were 6.15% and 4.62% respectively, with no statistical significance （P〉0.05）. Conclusions Enhanced atorvastatin therapy is effective in reducing the occurrence of perioperative inflammatory response and myocardial injury of PCI in pa- tients with ACS, and, it＇ s worthy of being widely applied in clinic.