阿托伐他汀预治疗对经皮冠脉介入术相关炎症及心肌损害的影响

Effect of atorvastatin pretreatment on percutaneous coronary intervention-related inflammation and myocardial injury

目的:探讨经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术前阿托伐他汀预治疗对PCI相关炎症及心肌损害的影响。方法:103例拟行PCI的冠心病病人完全随机分为对照组(n=30)、低剂量预治疗组(n=36)和高剂量预治疗组(n=37)。对照组病人术前不服用阿托伐他汀,低剂量与高剂量组病人术前分别口服20、40 mg阿托伐他汀片剂1～3 d。术后所有病人均口服阿托伐他汀20 mg,1次/晚。测定术前、术后中性粒细胞计数、超敏C反应蛋白、髓过氧化物酶和术后肌钙蛋白I,并记录围手术期心肌梗死的发生率。结果:高剂量预治疗组术后髓过氧化物酶升高值明显小于对照组(P<0.05),但低剂量组与对照组间无统计学差异(P>0.05)。3组病人术前与术后的超敏C反应蛋白水平、中性粒细胞计数无显著性差异(P>0.05)。高剂量预治疗组病人心肌梗死发生率最低,但组间无显著性差异。结论:PCI术前阿托伐他汀40 mg预治疗1～3 d可以抑制PCI相关炎症,并可能对心肌损害具有保护作用。

Objective：To explore the effect of atorvastatin pretreatment on percutaneous coronary intervention（PCI）-related inflammation and myocardial injury.Methods：One hundred and three patients with coronary heart diseases undergoing PCI were randomized into control group（n=30）,low-dose pretreatment group（n=36） and high-dose pretreatment group（n=37）.They were given 0,20 and 40 mg atorvastatin tablet for 1 to 3 days before PCI,respectively.All patients took 20 mg atorvastatin every night after PCI.The neutrocyte count,the levels of high sensitivity C reactive protein（hs-CRP） and myeloperoxidase（MPO） were determined before and after PCI,and the level of cardiotroponin I（cTnI） was determined after PCI.The incidence of peri-procedural myocardial infarction was recorded.Results： The degree of MPO elevation in high-dose pretreatment group was significantly less than that of control group（P〈0.05）,but there was no statistically significant difference between the low-dose pretreatment group and control group（P〉0.05）.The changes of hs-CRP level and neutrocyte count were not significant before and after PCI in 3 groups（P〉0.05）.Incidence of peri-procedural myocardial infarction was lowest in the high-dose pretreatment group.However,there was no significant difference among the 3 groups.Conculsion： Pretreatment with atorvastatin 40 mg for patients undergoing PCI for 1 to 3 days can inhibit PCI-related inflammation and may have a protective effect against myocardial injury.