他汀序贯疗法在择期经皮冠状动脉介入治疗患者中降脂和抗炎作用的疗效观察

目的：评估阿托伐他汀钙序贯治疗对择期经皮冠状动脉介入治疗（PCI）患者的血脂及特异性炎性因子的影响，同时评估其安全性。方法88例择期PCI患者随机分为序贯组（43例）及常规组（45例）。在用药前及用药后3 d、1个月、3个月及6个月抽取外周静脉血，用双抗体夹心酶联免疫法（ELISA）检测血清中的髓过氧化物酶（MPO）及基质金属蛋白酶9（MMP-9），同时观察总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、谷丙转氨酶（ALT）、总胆红素（BIL）、肌酸激酶（CK）、γ-谷氨酰转肽酶（γ-GGT）等指标，分别评估两组的抗炎作用、调脂疗效和不良反应及事件的发生率，分析其组间差异。结果序贯组和对照组的TC及LDL-C在治疗后均明显下降，差异有统计学意义（P＜0.05）。研究比较发现，两组TC及LDL-C的在治疗后3 d均出现明显的下降趋势（下降幅度：TC 26.6%比14%；LDL-C 36.9%比19.4%），两组间比较差异有统计学意义（P＜0.05）。在治疗1个月时，两组的TC及LDL-C进一步降低，其中LDL-C组间差异有统计学意义（45.0%比26.9%，P＜0.05）在第3个月及第6个月时的差异仍具有统计学意义（P＜0.05）。炎性指标：两组患者的MMP-9及MPO治疗后较治疗前相比，两者差异均有统计学意义（P＜0.05）。序贯组的MPO在治疗后明显降低，与治疗前比较差异有统计学意义（F=18.455，P=0.000）。然而，MPO在治疗后两组间比较差异无统计学意义（P＞0.05）。两组患者的MMP-9治疗后与治疗前比较，差异均有统计学意义（序贯组：F=46.911，P=0.000；对照组：F=19.156，P=0.000）。在治疗后3 d，序贯组和试验组MMP-9组间比较，差异有统计学意义（P＜0.05）；在治疗后1个月、3个月及6个月的差异均有统计学意义（P＜0.05）。两组患者的不良反应及不良事件发生率比较，差异无统计学意义（P＞0.05）。结论序贯治疗和常规治疗均可有效降低血脂，序贯治疗的降脂效果更强。两种疗法均能有效地抑制炎症因子，序贯治疗可更有效地抑制MMP-9，可能有利于进一步稳定斑块，防止其破裂。

Efficacy of lipid-lowering and anti-inflammatory effects of statins sequential therapy in coronary ;heart disease patients undergoing elective PCI

Objective To assess the inlfuence and safety of early atorvastatin sequential therapy in coronary heart disease （CHD） patients underdoing elective percutaneous coronary intervention on selected indicators of inflammation and serum lipids. Methods A total of 88 CHD patients who got ready to receive the elective percutaneous coronary intervention （PCI） were divided in two groups at random：The sequential dose group was called group A （atorvatatin 80mg as loading dose ,40 mg/d for 1 month after＆amp;nbsp;PCI and 20 mg/d subsequently, n=43）, and the ordinary dose group was called group B （ atorvastatin 20 mg/d, n=45）. During the follow-up, blood samples were taken at baseline, 3 days,1 month, 3 months and 6 months for myeloperoxidase （MPO）, matrix metalloproteinase-9（MMP-9）, serum lipids, serum alanine aminotransferase （ALT）, glutamyl endopeptidase （GGT） and creatine kinase （CK） levels. Main adverse cardiac events and adverse effects were also analyzed. Results Compared with the baseline, the level of low-density lipoprotein-cholesterol （LDL-C） and total cholesterol （TC） was signiifcantly decreased in both two groups after treatment （P ＆lt; 0.05）. The LDL-C and TC in both groups were all decreased after treatment, and the degree of LDL-C and TC decreased at 3 days had signiifcant differences between the two groups （TC：26.6%vs. 14.0%;LDL-C：36.9%vs. 19.4%, both P＆lt;0.05）. The degree of LDL-C decreased at 1 month between the two groups also had signiifcant differences （45.0%vs. 26.9%;P＆lt;0.05）. The changes in LDL-C and TC level were also signiifcantly different between the two groups at 3 and 6 months （P＆lt;0.05）. While TG and HDL-C remained unchanged. MMP-9 and MPO were both reduced post medication compared to pre-treatment levels （P＆lt;0.05）. MPO was decreased signiifcantly in group A after treatment （F=18.455, P=0.000）. And the same differences in group B were also signiifcant （P ＆lt; 0.05）. MPO post medication between the 2 groups were not significantly different （P ＆gt; 0.05）. Reduction in MMP-9 also showed signiifcant in both groups after treatment （group A：F=46.911, P=0.00;group B：F=19.156, P=0.00）. The adverse effects had no signiifcant differences between the 2 groups （P＆gt;0.05）. Conclusions The atorvastatin sequential theapy in CHD patients undergoing elective percutaneous coronary intervention could decrease serum lipids signiifcantly. Pretreatment with atorvastatin for patients undergoing PCI could inhibit inlfammation. The MACE and adverse effects were similar between the two groups.