他汀类药物对急性心肌梗死后并发房颤的影响及临床意义

Impact and clinical significance of statins on acute myocardial infarction with atrial fibrillation

目的探析他汀类药物预防心肌梗死后房颤发生的作用。方法回顾性分析韶关市始兴县人民医院2012年2月～2014年3月收治的急性心肌梗死后并发房颤患者64例的临床资料,根据急性心肌梗死后房颤患者是否使用他汀类药物治疗,将其分为治疗组（41例）和对照组（23例）,治疗组患者给予他汀类药物治疗,对照组患者未使用他汀类药物治疗。分析两组治疗前及治疗后3个月血脂指标水平、缺血有关事件及房颤类型变化情况。结果①治疗组治疗后3个月总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）水平均明显低于同组治疗前,而高密度脂蛋白胆固醇（HDL-C）水平则明显高于治疗前,差异均有统计学意义（P〈0.05）;对照组治疗前后各项血脂项目水平差异无统计学意义（P〉0.05）。治疗组治疗后3个月TC、TG、LDL-C、HDL-C水平与对照组同时期比较,差异均有统计学意义（P〈0.05）。②疗组治疗后3个月心力衰竭、冠心病恶化入院、心源性死亡、脑卒中等缺血性相关事件发生率[4.9%（2/41）、7.3%（3/41）、4.9%（2/41）、4.9%（2/41）]均明显低于对照组[13.0%（3/23）、13.0%（3/23）、13.0%（3/23）、8.7%（2/23）],差异均有统计学意义（P〈0.05）。③治疗组治疗后3个月阵发性房颤、持续性房颤、永久性房颤发生率[4.9%（2/41）、2.4%（1/41）、2.4%（1/41）]均明显低于对照组[26.1%（6/23）、17.4%（4/23）、8.7%（2/23）],差异均有统计学意义（P〈0.05）。结论他汀类药物可发挥心肌梗死后房颤一级和二级预防作用,改善心血管病患者预后。

Objective To discuss and analyze the action of statins on prevention of acute myocardial infarction with atrial fibrillation. Methods Clinical data of 64 patients with acute myocardial infarction combined with following atrial fibrillation from February 2012 to March 2014 in the People＇s Hospital of Shixing County were retrospectively analyzed and divided into treatment group（41 cases） and control group（23 cases） according to whether statins was used or not after the acute myocardial infarction. The indexes of serum lipid parameter, ischemic events, atrial fibrillation types in the two groups before treatment and 3 months after treatment were evaluated. Results ①The TC, TG, LDL-C level in treatment group 3 months after treatment were all lower than those before treatment, the HDL-C level was higher than that before treatment, the differences were statistically significant（P〉0.05）. The differences of indexes of serum lipid parameter in control group before and after the treatment was not statistically significant（P〈0.05）. The differences of TC, TG, LDL-C, HDL-C level 3 months after treatment between the two groups were statistically significant（P〈0.05）.②The occurrence rate of heart failure, coronary heart disease deterioration, cardiac death, cerebral apoplexy 3 months after the treatment in treatment group [4.9%（2/41）, 7.3%（3/41）, 4.9%（2/41）, 4.9%（2/41）] were all lower than those in control group [13.0%（3/23）, 13.0%（3/23）, 13.0%（3/23）, 8.7%（2/23）], the differences were statistically significant（P〈0.05）. ③The occurrence rate of paroxysmal atrial fibrillation, persistent atrial fibrillation, permanent atrial fibrillation in treatment group 3 months after the treatment [4.9%（2/41）, 2.4%（1/41）, 2.4%（1/41）] were all lower than those in control group in the same term [26.1%（6/23）, 17.4%（4/23）, 8.7%（2/23）], the differences were statistically significant（P〈0.05）. Conclusion Statins plays the roles of first and second level of prevention for AMI with atrial fibrillation and improve prognosis of patients with cardiovascular diseases.