STEMI急诊 PCI术前负荷剂量阿托伐他汀对心肌血流灌注及血清 sCD40 L水平的影响

目的：探讨ST段抬高型心肌梗死（ST-Segment elevation myocardial infarction ， STEMI）患者急诊经皮冠状动脉介入术（percutaneous coronary intervention ， PCI）前给予80 mg阿托伐他汀强化治疗对术后心肌血流灌注及血清 sCD40L的影响。方法对拟行急诊PCI的STEMI（＜12 h）患者，随机分为A、B、C 3组。 A组术前阿托伐他汀80 mg，术后40 mg/晚，1个月后改为20 mg/晚；B组术前未给予阿托伐他汀，术后40 mg/晚，1个月后改为20 mg/晚；C组术前未给予阿托伐他汀，术后20 mg/晚。观察术后即刻TIMI血流分级、校正TIMI血流帧数（corrected TIMI frame count，cTFC）以及各组术前、术后24 h、术后7 d及术后30 d血清sCD40L的水平变化；同时记录用药期间的药物不良反应。结果术后cTFC比较，A组（25．44±12．07）显著小于B组（30．98±12．09）、C组（33．49±14．56），差异有统计学意义（P＜0．05）；而3组间TIMI3级血流比例依次为91．7％（44/48）、88．4％（38/43）、86．7％（39/45），组间比较，差异无统计学意义。急诊PCI术后24 h及7 d，A组血清sCD40L水平（16．18±4．52）ng/ml，（3．92±1．44）ng/ml]低于B组（18．25±5．02）ng/ml，（4．63±1．68）ng/ml]及C组（18．66±4．17）ng/ml，（4．68±1．51）ng/ml]，差异有统计学意义（P＜0．05）；术后30 d 3组间比较无统计学差异。3组用药期间无严重药物不良反应发生。结论 STEMI患者急诊PCI术前给予负荷剂量阿托伐他汀治疗可显著改善术后心肌血流灌注及炎性反应程度，且安全性好。

Effects of a loading-dose atorvastatin before primary percutaneous coronary intervention on coronary blood perfusion and serum sCD40 L in patients with ST-segment elevation myo-cardial infarction

Objective To study the effects of a loading-dose atorvastatin on the coronary blood pefusion and serum sCD 40L af-ter primary PCI in STEMI patients .Methods STEMI patients who were prepared for primary PCI were randomly divided into three groupgroup A （ received atorvastatin 80 mg loading dose before PCI then followed by 40 mg daily for one month and a maintenance dose of 20 mg daily thereafter ） , group B （ received atorvastatin 40 mg daily after PCI for one month and a maintenance dose of 20 mg daily thereafter） and group C （received atorvastatin 20 mg daily after PCI）.TIMI flow grade and corrected TIMI frame count （cTFC） after PCI were recorded and compared between the three groups .In addition, the serum sCD40L was measured at admission and 24 h, 7 d, 30 d after PCI.Adverse reactions were monitored during 30 d follow-up.Results The cTFC in group A （25.44 ±12.07） was significamtly lower than that in group B （30.98 ±12.09） or that in group C （33.49 ±14.56） （P〈0.05）;The percentages of TIMI grade 3 were 91.7%（44/48）,88.4%（38/43）,86.7%（39/45） in group A, group B and group C respectively , and no significant difference was found among the three groups .The levels of serum sCD40L at 24 h and 7 d after PCI in group A （16.18 ±4.52） ng/ml, （3.92 ±1.44） ng/ml]were significantly lower than those in group B （18.25 ±5.02） ng/ml, （4.63 ±1.68） ng/ml] and group C （18.66 ±4.17） ng/ml,（4.68 ±1.51） ng/ml].But the levels of sCD40L in the three groups did not reach statistical differences at 30 d after PCI.No severe adverse reactions were observed during study period .Conclusions For STEMI patients who undergo pri-mary PCI, a loading-dose of atorvastatin before PCI can reduce serum sCD 40L level, improve immediate coronary blood perfusion and does not increase the incidences of adverse events .