急诊经皮冠状动脉介入治疗术前阿托伐他汀对心肌梗死患者MMP-9和hs—CRP的影响

Effect of intensive treatment of 80 mg atorvastatin on serum inflammatory factor and matrix metalloproteinase - 9 in ST - segment elevation acute myocardial infarction patients before emergency

目的探讨急诊经皮冠状动脉介入治疗（PCI）术前80mg阿托伐他汀对ST段抬高型急性心肌梗死（STEMI）患者血清高敏C反应蛋白（hs—CLIP）和基质金属蛋白酶-9（MMP-9）的影响。方法将发病12h内拟行急诊PCI的STEMI患者，按照随机信封法分为3组：A组（术前阿托伐他汀80mg＋术后每天40mg阿托伐他汀）；B组（术后每天40mg阿托伐他汀）；C组（术后每天20mg阿托伐他汀）。3组患者分别于术前、术后24h、术后7d测定血清hs—CRP、MMP-9、ALT与AST水平。结果3组间术前血清hs—CRP及MMP-9水平比较差异无统计学意义，A组PCI术后24h血清hs—CRP及MMP-9水平分别为（7．19±0．90）mg／L及（1．47±0．26）ng／L，低于B组、C组，但差异无统计学意义（P〉0．05）；术后7d，A组血清hs—CRP及MMP-9水平分别为（5．69±1．42）mg／L及（1．18±0．29）ng／L，与B组、C组比较差异有统计学意义（P〈0．05），而B组与C组比较差异无统计学意义（P〉0．05）。术后A组在研究期间内药物安全性与B、C两组比较差异无统计学意义（P〉0．05）。结论急诊PCI术前给予80mg阿托伐他汀强化治疗可显著降低STEMI患者围手术期血清炎性因子水平，同时增加斑块的稳定性。

Objective To evaluate the effect of 80 mg atorvastatin on serum inflammatory factor and matrix metalloproteinase - 9 （ MMP - 9 ） in ST - segment elevation acute myocardial infarction （STEMI） patients before emergency percutaneous coronary intervention （PCI）. Methods From May 2010 to December 2011, 102 patients diagnosed as STEMI according to the clinical syndrome were divided into three groups at random： group A： 80 mg atorvastatin before PCI ＋ 40 mg atorvastatin once a day after PCI; group B ： 40 mg atorvastatin once a day after PCI ; group C ： 20 mg atorvastatin once a day after PCI. ECG and cardiac enzyme were enrolled in this study. The serum level of high sensitive C - reactive protein （hs -CRP） and MMP -9 as well as the ALT and AST were compared among the three groups in different time points （before emergency PCI, 24 hours after emergency PCI, 7 days after emergency PCI）. Results There were no differences in the serum levels of hs - CRP and MMP - 9 among three groups on admission. The serum levels of hs -CRP and MMP -9 was （7.19±0.90） mg/ L and （ 1.47±0.26 ） ng/L respectively in group A 24 hours after emergency PCI, but no significant differences were found among three groups. On 7th day after emergency PCI, the serum levels of hs - CRP and MMP -9 decreased continuously [ （5.69±1.42） mg/L and （ 1.18±0.29） ng/L] , which were statistically lower in group A than those in group B and group C （ P 〈 0.05 ）. During the study period, the adverse reaction was similar in three groups. Conclusion The intensive treatment of 80 mg atorvastatin before emergency PCI might be safe and could significantly lower the serum level of hs - CRP and MMP -9, and improve the stability of coronary plaque.