负荷量加高维持量的阿托伐他汀在ACS患者介入治疗后的临床应用效果

Clinical effect of loading dose and high maintenance dose of atorvastatin in patients with acute coronary syndrome after interventional treatment

目的 观察负荷量加高维持量的阿托伐他汀在急性冠脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）后的临床应用效果。方法 选取2012年1月~2013年6月解放军201医院收治的接受介入治疗的ACS患者80例。随机分为对照组和观察组，每组各40例。两组患者均进行常规药物治疗和经皮冠状动脉介入治疗。术后对照组给予20 mg/d的阿托伐他汀口服，观察组术后第1 d给予80 mg阿托伐他汀，第2 d起降低剂量为40 mg/d，1月后改为20 mg/d。检测两组患者治疗前后低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、三酰甘油（TG）、总胆固醇（TC）、N末端脑钠肽前体（NTproBNP）、左室射血分数（LVEF）、白介素-18（IL-18）、白介素-6（IL-6）、超敏C反应蛋白（hs-CRP）、内皮素-1（ET-1）及一氧化氮（NO）水平，记录出院后1年内两组患者发生心血管事件的情况。结果 经过1个月的治疗后，两组患者较治疗前LDL-C、TG、TC、NT-proBNP下降，HDL-C升高，差异具有统计学意义（P均＜0.05）。与对照组治疗后比较，观察组LDL-C、TG、TC、NT-proBNP下降，HDL-C和LVEF升高，差异具有统计学意义（P均＜0.05）。两组治疗1个月后较治疗前IL-18、IL-6、hs-CRP及ET-1下降，NO升高，差异具有统计学意义（P均＜0.05）。与对照组治疗后比较，观察组IL-18、IL-6、hs-CRP及ET-1下降，NO升高，差异具有统计学意义（P均＜0.05）。与对照组比较，观察组心血管事件发生率降低（75% vs. 10%），差异具有统计学意义（P＜0.01）。结论 负荷量加高维持量的阿托伐他汀较常规治疗可有效改善ACS患者介入治疗后的血脂和炎症因子水平，改善左心功能和血管内皮功能，降低心血管事件的发生。

Objective To observe the clinical effect of loading dose and high maintenance dose ofatorvastatin in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI).Methods ACS patients (n=80) were chosen from Jan. 2012 to Jun. 2013, and randomly divided into controlgroup and observation group (each n=40). All patients were given routine drug therapy and PCI, and then controlgroup was given atorvastatin (20 mg/d) after PCI, and observation was given atorvastatin (80 mg) 1 d after PCI,atorvastatin in decreased dose (40 mg/d) 2 d after PCI and atorvastatin (20 mg/d) 1 m after PCI. The levels of lowdensitylipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), triglyceride (TG), totalcholesterol (TC), N-terminal pro brain natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF),interleukin-18 (IL-18), interleukin-6 (IL-6), high sensitivity C-reactive protein (hs-CRP), endothelin-1 (ET-1)and nitric oxide (NO) were detected in 2 groups, and the incidence of major adverse cardiovascular events (MACE)was recorded within 1 y after discharged from hospital. Results After treatment for 1 m, the levels of LDL-C, TG,TC and NT-proBNP decreased and HDL-C increased in 2 groups (all P<0.05). Compared with control group aftertreatment, the levels of LDL-C, TG, TC and NT-proBNP decreased and HDL-C and LVEF increased in observationgroup (all P<0.05). After treatment for 1 m, the levels of IL-18, IL-6, hs-CRP and ET-1 decreased and NOincreased in 2 groups (all P<0.05). Compared with control group after treatment, the levels of IL-18, IL-6, hs-CRP and ET-1 decreased and NO increased in observation group (all P<0.05). Compared with control group, theincidence of MACE decreased in observation group (75% vs. 10%, P<0.01). Conclusion Atorvastatin in loadingdose and high maintenance dose can effectively recover the levels of blood fat and inflammatory factors, improve leftheart function and reduce MACE incidence compared with routine therapy in ACS patients.