急性冠脉综合征患者负荷量阿托伐他汀对择期经皮冠脉介入术诱导的炎症反应与心肌损伤的影响

Effects of Loading-dose Atorvastatin on Inflammation and Myocardial Damage in Acute Coronary Syndrome Patients Undergoing Selected Percuneous Coronary Intervention

【目的】探讨我国急性冠脉综合征患者择期冠脉介入术(PCI)术前给予负荷量阿托伐他汀对术后炎症因子与心肌损伤标志物的影响。【方法】入选2008年11月至2009年7月在我院行择期冠脉介入术的急性冠脉综合征连续病例85例,随机分为实验组和对照组,分别为42例和43例。实验组在阿托伐他汀20mg/d基础上,术前8h再给予负荷量阿托伐他汀80mg,对照组仅给予阿托伐他汀20mg/d。分别在术前、术后6h及术后24h检测炎症因子单核细胞趋化因子-1(MCP-1)及可溶性CD40配体(SCD40L),术前及术后24h检测心肌损伤标记物CK-MB。【结果】实验组内比较,MCP-1在PCI术前与术后6h,24h差别无显著性,P>0.05,SCD40L水平在PCI术后24h较术前及术后6h均明显降低,P值分别为0.019,0.011,CK-MB在PCI术前与术后24h差别无统计学意义,P>0.05;对照组内比较,MCP-1与SCD40L在PCI术前与术后6h,24h的差别均无统计学意义,P>0.05,CK-MB水平在PCI术后24h较术前明显升高,P<0.001;实验组与对照组间比较,术前及术后6h两组间MCP-1及SCD40L无差异,术后24h实验组MCP-1及SCD40L较对照组明显下降,P值分别为0.028,0.036。CK-MB两组术前差别无统计学意义,术后24h实验组较对照组明显降低,P=0.009。【结论】急性冠脉综合征患者择期PCI术前8h给予负荷量阿托伐他汀80mg能够降低术后24h的炎症因子MCP-1及SCD40L水平,并能减轻心肌损伤。

【Objective】To investigate the effects of loading-dose atorvastatin on inflammation and myocardial damage in acute coronary syndrome patients undergoing selected percutaneous coronary intervention（PCI）.【Methods】Eighty-five acute coronary syndrome patients underwent selected PCI were enrolled.All patients were given atorvastatin 20 mg/d,while study group received loading-dose atorvastatin 80 mg before 8 hours of PCI,monocytes chemotactic factor-1（MCP-1）and soluble CD40 ligand（SCD40L）were measured respectively at pre-PCI as well as 6 hours and 24 hours after PCI.CK-MB was measured at pre-PCI and 24 hours after PCI.【Results】In study group,the MCP-1 levels measured at pre-PCI as well as 6 hours and 24 hours after PCI were not statistically different.The SCD40L level measured after 24 hours of PCI was lower than that of measured at pre-PCI and 6 hours after PCI,P0.05.The CK-MB levels measured at pre-PCI and 24 hours after PCI were not statistically different.In control group,The MCP-1 and SCD40L levels measured at pre-PCI as well as 6 hours and 24 hours after PCI were similar.The CK-MB level after 24 hours of PCI was higher than that of measured at pre-PCI,P0.001.As compared with control group,the MCP-1 and SCD40L levels in study group were similar at pre-PCI and 6 hours after PCI,but significantly decreased at 24 hours after PCI.The CK-MB in study group was significantly decreased than that in control group at 24 hours after PCI.【Conclusion】For acute coronary syndrome patients,loading-dose atorvastatin（80 mg）used before 8 hours of selected PCI could decrease the levels of MCP-1,SCD40L,and CK-MB measured at 24 hours after PCI.