不同剂量阿托伐他汀对直接经皮冠脉介入治疗者心肌再灌注的影响

目的：观察不同剂量阿托伐他汀对ST段抬高型心肌梗死（ STEMI）患者直接经皮冠脉介入治疗（ PCI）后对心肌细胞及冠脉血流的影响。方法：选择120例急性心肌梗死（AMI）患者,随机分为40 mg阿托伐他汀组（n=60）和80 mg阿托伐他汀组（n=60）。入选者均在发病6h内行直接PCI治疗,记录冠脉病变程度、心肌梗死溶栓治疗试验（TIMI）分级；比较两组间的一般状况、冠脉造影及介入治疗结果；观察两组再灌注损伤事件的发生情况；综合评价阿托伐他汀对急性MI/RI后的保护作用及其相关机制。结果：两组间一般情况、临床生化指标、冠脉病变分布情况未见统计学差异（ P﹥0．05）； PCI术后梗死相关动脉（IRA）的TIMI3级血流获得率未见统计学差异（P﹥0．05）,均无无复流发生；两组直接PCI术后90 min心电图ST段回落（STR）率有统计学差异（P〈0．05）； PCI术后两组均出现再灌注心律失常（RA）,80 mg阿托伐他汀组RA的发生率大于40 mg阿托伐他汀组,差异有统计学意义（P〈0．05）；两组均未出现严重心脏不良事件（P﹥0．05）。结论：阿托伐他汀减轻AMI患者直接PCI术后MI/RI,进而改善近期临床预后,且80 mg阿托伐他汀改善冠脉血流功能作用优于40 mg阿托伐他汀。

Effects of Different Doses of Atorvastatin on Myocardial Perfusion by Direct PCI

OBJECTIVE： To investigate the effect of myocardial perfusion after different doses of atorvastatin on the ST-segment elevation myocardial infarction in patients treatad by direct percutaneous coronary intervention （ PCI） . METHODS： 120 patients who were diagnosed as acute myocardial infarction （AMI） were randomly divided into two groups： 40mg atorvastatin group （n=60） and 80mg atorvastatin group （n=60）. The patients accepted the PCI treatment in 6 hours. The degree of coronary lesions and TIMI flow grade were recorded. The study comprehensivly evaluated the protective effect and mechanism of atorvastatin after acute MI/RI. RE-SULTS： ①There were no statistical significant difference in baseline clinical characteristics and the distribution of coronary artery le-sions between two groups （P〉0. 05）; ②There were no significant difference in percentage of TIMI 3 flow achieved in IRA after PCI between the two groups （P〉0. 05）. No-reflow didn’ t occur in both groups; ③There was statistically significant difference in ST segment within 90 minutes after PCI in the two groups （P〈0. 05）; ④Reperfusion arrhythmias were occurred in both groups, and the rate of reperfusion arrhythmias in 80 mg atorvastatin group was higher than that in the 40 mg atorvastatin group （P〈0. 05）; ⑤There were no myocardial re-infarction, target vessel revascularization, shock and death during hospitalization in two groups. CONCLU-SION： Atorvastatin can reduce cardiac myocyte apoptosis, protect mitochondrial function and relieve the ischemic reperfusion injury in patients with AMI after direct PCI.