急诊PCI术前阿托伐他汀强化治疗对STEMI患者血清炎症因子的影响

Influence of intensive atorvastatin treatment on serum inflammatory factors in STEMI patients before emergency PCI

目的:探讨术前给予80mg阿托伐他汀强化治疗对ST段抬高急性心肌梗死(STEMI)患者急诊介入治疗前后炎症反应的影响。方法:入选STEMI的患者95例,随机分为三组:A组(31例,术前给予负荷剂量阿托伐他汀80mg,术后给予阿托伐他汀40mg/d);B组(34例,术前不服用他汀类药物,术后给予阿托伐他汀40mg/d);C组(30例,术前不服用他汀类药物,术后给予常规剂量阿托伐他汀20mg/d)。分别于术前,术后24h、3d、7d测定各组血清高敏C反应蛋白(hsCRP)、血清淀粉样蛋白酶A(SAA)水平及术后肌酸激酶-同工酶(CK-MB)的峰值。结果:三组间术前血清hsCRP及SAA水平无明显差异;术后3d及7d,A组血清hsCRP及SAA水平明显低于B组、C组[7d:hsCRP(5.64±1.55)mg/L比(8.36±2.32)mg/L、(7.66±2.53)mg/L,SAA(7.31±3.61)mg/L比(10.13±5.13)mg/L、(12.86±4.98)mg/L,P<0.05];而B组与C组间无显著差异(P>0.05)。术后A组CK-MB峰值水平明显低于B、C组[(233.9±102.71)IU/L比(319.40±111.10)IU/L、(373.6±174.87)IU/L,P<0.05],而B组与C组间无显著差异(P>0.05)。A组在研究期间药物安全性与B、C两组比较亦无显著差异。结论:急诊PCI术前给予80mg阿托伐他汀强化治疗可显著降低ST段抬高急性心肌梗死患者血清炎性因子水平及肌酸激酶-同工酶峰值水平,且安全性良好。

Objective： To study influence of intensive treatment of 80rag atorvastatin on inflammatory factors before emergency percutaneous coronary intervention （PCI） in patients with ST-segment elevation myocardial intervention （STEMI）. Methods： A total of 95 STEMI patients were enrolled and randomly divided into three groups., group A [n = 31, received loading dose of atorvastatin （80mg） before PCI and 40mg/d atorvastatin after PCI], group B （n = 34, only received 40mg/d atorvastatin after PCI） and group C [n = 30, no received statin before PCI, but received routine dose of atorvastatin （20mg/d） after PCI]. Measurements were performed on serum levels of high sensitive C reactive protein （hsCRP）, serum amyloid-a （SAA） before, 24h, 3d and 7d after PCI, and peak level of creatinine kinase-MB （CK-MB） after PCI in all groups. Results： There were no significant difference in serum levels of hsCRP and SAA before PCI among three groups; on 3d and 7d after PCI, serum levels of hsCRP and SAA in group A were significantly lower than those of group B and C [-7d： hsCRP （5. 64 ± 1.55） mg/L vs. （8.36 ± 2.32） mg/L, （7.66 ± 2.53） mg/L, SAA （7.31 ± 3.61） mg/L vs. （10.13 ± 5.13） mg/L, （12.86 ± 4.98） mg/L, P〈0.05], but for those there were no significant difference between group B and C （P〉0.05）. After PCI, peak level of CK-MB in group A was significantly lower than those of group B and C [- （233.9 ± 102.71） IU/L vs. （319.40 ± 111.10） IU/L, （373.6± 174.87） IU/L, P〈0.05], and there was no significant difference also between group B and C （P〉 0.05）. During the present study, there was no significant difference in drug safety among three groups. Conclusion： Intensive treatment of 80mg atorvastatin before emergency PCI can significantly decrease serum level of inflammatory factors and peak level of CK-MB in acute STEMI patients, and possesses good safety.