阿托伐他汀早期强化治疗对STEMI患者急诊PCI术后的影响

Influences of early intensive treatment of atorvastatin on results of emergency PCI in patients with STEMI

目的：探讨急诊经皮冠状动脉介入术（PCI）术前阿托伐他汀强化治疗对ST段抬高心肌梗死（STEMI）患者术后ST段回落、血清炎症因子及内皮功能的影响。方法纳入2010年3月~2010年12月武警总医院发病时间＜12 h、拟行急诊PCI的STEMI患者95例，按照随机信封法随机分为3组：A组（n=34，术前给予负荷剂量阿托伐他汀80 mg，术后给予阿托伐他汀40 mg/d）；B组（n=34，术前不服用他汀类药物，术后给予阿托伐他汀40 mg/d）；C组（n=30，术前不服用他汀类药物，术后给予常规剂量阿托伐他汀20 mg/d），观察术后90 min内ST段回落情况以及术后24 h、3 d、7 d高敏C反应蛋白（hs-CRP）及NO合酶（NOS）的变化情况。结果术后90 min内A组ST段回落比例更高，同时回落幅度也更大，与B组和C组均有统计学差异（P＜0.05）；术后24 h，A组高敏C反应蛋白（hs-CRP）水平下降，但与B组和C组无统计学差异；术后3 d和7 d，A组hs-CRP进一步下降，且与B组和C组达到统计学差异（P＜0.05）；术后24 h及术后3 d，A组一氧化氮合成酶（NOS）水平高于B组和C组，但与B组和C组比较无统计学差异（P＞0.05）；术后7 d，A组NOS水平继续升高，与B组和C组达到统计学差异（P＜0.05）。结论急诊PCI术前一次性给予大剂量（80 mg）阿托伐他汀强化治疗有利于STEMI患者心肌灌注恢复，并能够降低炎症反应，改善血管内皮功能。

Objective To investigate the influences of pre-operation intensive treatment of atorvastatin （80 mg） on post-operation ST-segment resolution index （STRI）, serum inflammatory factors and endothelial function in the patients with ST-segment elevation myocardial infarction （STEMI）. Methods The STEMI patients （n=95, onset〈12 h） who planed accepting emergency PCI were chosen from the General Hospital of Chinese People’ s Armed Police Forces from Mar. 2010 to Dec. 2010, and randomly divide into group A （n=34, 80 mg atorvastatin before PCI and 40 mg/d after PCI）, group B （n=34, no atorvastatin before PCI and 40 mg/d after PCI） and group C （n=30, no atorvastatin before PCI and 20 mg/d after PCI）. The changes of STRI within 90 min after PCI, and high sensitivity C-reactive protein （hs-CRP） and NO synthase （NOS） after PCI for 24 h, 3 d and 7 d were observed. Results Within 90 min after PCI, the percentage and extent of ST-segment resolution were higher in group A compared with those in group B and group C （P〈0.05）. After PCI for 24 h, the level of hs-CRP decreased in group A, which had no statistical difference compared with group B and group C. After PCI for 3 d and 7 d, the level of hs-CRP decreased further in group A, which had statistical difference compared with group B and group C （P〈0.05）. After PCI for 24 h and 3 d, the level of NOS was higher in group A than that in group B and group C, which had no statistical difference （P〉0.05）. After PCI for 7 d, the level of NOS increased continuously in group A, which had statistical difference compared with group B and group C （P〈0.05）. Conclusion The one-time administration of high-dose atorvastatin （80 mg） before emergency PCI is benefit to alleviate the myocardial perfusion and inflammatory reactions, and improve vascular endothelial function in STEMI patients.