普伐他汀对体外循环下冠状动脉旁路移植术患者血脂和高敏C反应蛋白的影响

Influence of pravastatin on blood lipids and serum high sensitive C-reactive protein in patients undergoing conventional coronary artery bypass grafting under on-pump： a clinical study of 81 cases

目的研究普伐他汀对常规体外循环冠状动脉旁路移植术（CCABG）患者血脂和高敏C反应蛋白（HsCRP）水平的影响。方法分析比较40例口服普伐他汀（20mg，每日1次），与41例冠状动脉旁路移植术（CABG）患者（对照组，不给予普伐他汀），术后不同时间血浆总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）和HsCRP水平。结果对照组术后24h血脂（TC、TG、HDL—C、LDL—C）均明显下降分别为（2．6±0．7）mmol/L，（0．56±0．26）mmol/L，（0．92±0．26）mmol/L，（1．4±0．5）mmol/L（P〈0．05），以后不同时段逐渐升高但仍明显低于术前（P〈0．05），28d恢复基线水平（P〉0．05）；普伐他汀组术后24h血脂（TC、TG、LDL-C）明显下降分别为（2．2±0．5）mmol/L，（0．70±0．23）mmol/L，（1．2±0．6）mmol/L（P〈0．05），TC以后各时段逐渐升高但仍低于术前（P〈0．05），28d恢复基线水平（P〉0．05），HDL手术前后变化差异无统计学意义（P〉0．05）。两组间比较，普伐他汀组TC、TG、LDL—C术后7、10、14、28d水平低于对照组（P〈0．05）。两组HsCRP均术后24h升高，72h达峰值，以后逐渐降低，对照组第10天后变化差异无统计学意义[（18±14）g/L，P〉0．05]，28d恢复基线水平；普伐他汀组第7天后变化差异无统计学意义[（12±10）g／L，P〉0．05]，14d恢复基线水平。两组间比较，普伐他汀组HsCRP术后各时间段水平均低于对照组（P〈0．05）。结论CCABG术后早期普伐他汀调脂治疗是安全的且能减轻术后体内炎症反应过程。

Objective To investigate the effect of pravastatin on blood lipids and serum high sensitive C-reactive protein （ HsCRP ） in patients undergoing conventional coronary artery bypass grafting under on-pump bypass（CCABG）. Methods Eighty-one patients underwent CCABG. Among which 40 took orally pravastatin 20 mg once daily to at least 28 days after operation, and 41 were used as control group. The serum levels of total cholesterol （TC）, triglyceride （TG）, HDL-C cholesterol （HDL-C）, LDL-C cholesterol （LDL-C） , and HsCRP were monitored before and 24 h, 72 h, 7 days, 10 days, 14 days, and 28 days postoperatively. Results In the control group the levels of different blood lipids after operation remarkably decreased after operation compared with those before operation （ all P 〈 0.05 ）, reached the lowest levels 24 h after operation, then gradually increased, however, still lower than those before operation （ all P 〈 0.05 ） , and recovered to the baseline level 28 hours after operation ; and the HsCRP level increased 24 h after operation and peaked 72 h after, then gradually decreased, and recovered to the baseline level 28 days after operation. In the pravastatin group the TC level reached its lowest level 24 h after operation, then gradually increased, however, still lower than that before operation, and recovered to the baseline level 28 days after operation ; and the TG level reached the lowest level 24 h after operation （ P 〈 0.05 ） , and then gradually increased 3 d after operation （P 〉0.05）. The TC, TG, and LDL-C levels 7, 10, 14, and 28 d after operation of the pravastatin group were all significantly lower than those of the control group （ all P 〈 0.05 ）. The HsCRP levels at different time points of the pravastatin group were all significantly lower than those of the control group （ all P 〈 0.05 ）. Conclusion The use of pravastatin in the early stage of CCABG is safe and can decrease systemic inflammatory reaction.