早期阿托伐他汀强化治疗对急性心肌梗死患者血清基质金属蛋白酶及预后的影响

Effects of early intensive atorvastatin treatment on serum matrix metalloproteinases and prognosis in patients with acute myocardial infarction

目的:探讨阿托伐他汀早期强化治疗对急性心肌梗死(AMI)患者基质金属蛋白酶(MMP)和预后的影响。方法:将176例AMI患者分为他汀治疗组(阿托伐他汀20mg/d,n=101)和非他汀组(n=75),入院后和治疗4周后分别测定血清MMP-1和MMP-9水平,同时测定血脂。另设健康对照组(n=70)与之比较。结果:治疗前他汀治疗组和非他汀组血清MMP-1、MMP-9水平均较对照组增高(P<0.001)。他汀治疗组治疗4周后血清MMP-1、MMP-9水平较治疗前均下降(P<0.001);非他汀治疗组4周后MMP-1、MMP-9水平无变化,与他汀治疗组相比差异有统计学意义(P<0.01或<0.001)。他汀治疗组治疗前后及非他汀治疗组治疗前后血脂与对照组比较均有差异(P<0.001)。他汀治疗组与非他汀治疗组1个月及1a时,2组终点事件发生率有差异(P<0.05)。结论:早期阿托伐他汀强化治疗可减少AMI患者粥样硬化斑块的基质成分降解,稳定斑块,改善预后。

Aim： To study changes of serum matrix metalloproteinases（MMP） and the influence on prognosis in patients with acute myocardial infarction（AMI） after early intensive statin treatment. Methods： A total of 176 patients with AM1 were randomly divided into group of intensive statin therapy（ n = 101, atorvastatin 20 mg/d）and group of non-statin treatment（ n = 75 ） , and 70 normal controls were subjected as control. After hospitalization and 4 weeks treatment the serum MMP-1 and MMP-9 and blood lipids were determined. Results： The serum levels of MMP-1 and MMP-9 in intensive statin therapy and non-statin treatment groups before treatment were significantly higher than those of control group（P 〈0. 001 ）. The serum MMP-1 and MMP-9 in intensive statin therapy group significantly decreased after treatment with atorvastatin for 4 weeks（P 〈 0.001 ） , while the non-statin treatment group had no significant changes, and there were significant differences in serum MMP-1 and MMP-9 between non-stain treatment group and intensive statin group（ P 〈 0. 001 or 0.01 ）. There were significant differences in blood lipids of intensive statin therapy and non-statin treatment groups compared with those of control group（ P 〈0. 001 ）. Compared with the non-statin treatment group,the incidence of end point cardiac events in the intensive therapy group significantly decreased after treatment with atorvastatin for one month and one year （ P 〈 0.05 ）. Conclusion： Early intensive atorvastatin treatment may reduce decomposition of the extracellular matrix of atherosclerosis plaque and prevent plaque to rupture in patients with AMI, thus improve prognosis.