不同剂量阿托伐他汀对不稳定型心绞痛介入术后患者的影响

Effect of different dosage atorvastation on patients with unstable angina post percutaneous coronary intervention

目的研究不同剂量的阿托伐他汀对不稳定型心绞痛患者经皮冠状动脉介入治疗术(PCI)后的炎症因子水平,调脂疗效及临床心脏事件的影响。方法选择在我院行PCI的148例不稳定型心绞痛患者为研究对象。随机分为阿托伐他汀常规剂量(10mg/d,对照组)70例和阿托伐他汀(20mg/d,观察组)78例。分别于术前当天、术后24h、用药2周、4周、12周、24周采集空腹静脉血,测定血清高敏C反应蛋白(hs-CRP)和肌钙蛋白I(cTnI)浓度及血脂,分析两组间差异及调脂疗效。并且术后24 h及用药后24周分别行彩色多普勒超声心动图检查,测定左心室射血分数(LVEF),观察LVEF与临床冠状动脉事件的变化。结果(1)两组患者PCI后hs-CRP及cTnI水平明显高于术前(P<0.01)。(2)观察组与对照组血清hs-CRP下降率,分别为4周40.0%比34.1%,12周59.4%比50.5%,24周72.9%比58.6%(P<0.05);血清cTnI下降率,分别为2周54.3%比37.8%(P<0.05),4周50.0%比42.2%。随访期内,观察组与对照组LVEF的上升率,24周时分别为39.0%比22.5%(P<0.05),两组不良心脏事件发生率差异无统计学意义。(3)观察组与对照组的血脂下降率在给药12周后,总胆固醇(TC)为21.7%比12.3%(P<0.05),给药24周后TC为23.4%比11.1%(P<0.05),低密度脂蛋白胆固醇(LDL-C)为29.5%比10.0%(P<0.05),差异有统计学意义。结论(1)PCI增加血清hs-CRP和cTnI水平。(2)不稳定型心绞痛患者PCI术后,应用阿托伐他汀降低炎症因子水平,改善心功能,20mg优于10mg。(3)服用阿托伐他汀20mg/d,可显著提高冠心病患者二级预防调脂的达标率。特别是LDL-C降至≤1.8mmol/L的目标值比例更高。

Objective To study the effect of different dosage of atorvastation on inflammatory factors, antilipiemic result and cardiac events in hospital in patients with unstable angina（UAP） post PCI. Methods The 148 patients with UAP who were done PCI in our hospital were divided randomly into two groups. Blood samples were examined at the day before the operation, 24 h after PCI, 2 W, 4 W, 12 W, 24 W after PCI. Echocardiogram was examined in 24 h after PCI and24 W after PCI. Echocardiograrn was examined in 24h after PCI and 24w after PCI. Results （ 1 ） The consistency of hs-CRP and cTnl of patient after PCI were more higher than which before PCI （ P 〈 0.01 ）. （2） The decreasing rate of hs-CRP of observe group and control group are 4 W 40.0 % vs 34.1% ; 12 W 59.4% vs 50.5 % ; 24 W 72.9 % vs 58.6% （P〈 0. 05）. The deereasingrateofcTnl between two groups were 2 W54.3% vs37.8% （P〈0.05）, 4W50.0% vs42.2%. In following time, the increasing rate of LVEF between them were 39.0% vs 22.5% on24 W （P〈0.05）. The different chance which happen cardiac events between two groups were not significant on statistics. （3） After 12 W, the decreasing rote of lipiemic between observe group and control group were21.7% vs 12.3% of TC （P〈0.05）;23.4% vs 11.1% of TC （P〈0.05） after 24 W;29.5% vs 10.0% of LDL-C （P〈0.05）. It was significant statistics. Conclusion（1） The level of hs-CRP and cTnl are increased by PCI. （2） The use of atorvastation 20mg/d seems better than that of 10mg/d in the field which decrease the level of inflammatory factors and improve function of cardiac on the UAP patients after PCI. （3） The use of atorvastation 20mg/d can greatly increase the rote of reaching standard which is Ⅱ grade prevention of the patients on CHD. The rote which decreasing LDL-C lower than 1.8mraolA is higher too.