他汀类药物对急性冠状动脉综合征合并心房颤动患者介入术后的心肌保护作用

Protective effect of statins on myocardium of patients with acute coronary syndrome combined with atrial fibrillation after PCI

目的观察急性冠状动脉综合征合并心房颤动患者行PCI术后,他汀类药物对围手术期心肌损伤的保护作用。方法选择具备PCI指征的急性冠状动脉综合征患者247例,分为合并心房颤动组(心房颤动组)132例和未合并心房颤动组(未心房颤动组)115例,在PCI术前开始服用他汀类药物,分别测量PCI术前及术后6h及1周时肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)及高敏C反应蛋白(hs-CRP)水平。结果 2组患者PCI术前CK-MB水平比较差异无统计学意义(P>0.05),心房颤动组患者cTnI、hs-CRP高于未心房颤动组(P<0.05);PCI术后6h,2组患者cTnl、CK-MB和hs-CRP均明显升高,心房颤动组升高更明显(P<0.05);PCI术1周后,2组患者上述指标均有所下降,心房颤动组下降较未心房颤动组明显,但未回复到术前水平。结论对急性冠状动脉综合征合并心房颤动的患者行PCI治疗,他汀类药物抗炎、保护心肌作用更强,其机制可能与他汀类药物的多效性相关。

Objective To investigate the protective effect of statins against the periprocedural myocardial damage in patients with acute coronary syndrome（ACS） combined with atrial fibrillation （AF） undergoing PCI. Methods 247 consecutive patients（mean age 67±12 years,135 males, 112 females） with ACS underwent PCI. They were divided into two groups. 132 combined with AF and 115 without. Troponin-I （cTnI）, creatine kinase-myocardial band （CK-MB）, and high-sensitivity C reactive protein（hs-CRP） were measured before and 6 hr and 1 week after PCI. Results No difference was found in CK-MB between the two groups,while cTnI and hs-CRP levels were higher in AF group before PCI （P〈 0.05）. The values of cTnI,CK-MB and hs-CRP all increased after PCI,and significantly higher in AF group than in non-AF group at 6 hour after PCI （P 〈 0.05）. One week after PCI with statin therapy, the levels of cTnI, CK-MB and hs-CRP were all decreased,and were significantly lower in AF group than in the non-AF group, but not attained those before PCI. Conclusion This study indicates that statin treatment has anti-inflamattory and protective effects on myocardium in patients with ACS combined with AF undergoing PCI, the mechanism may be related to its pleiotropic effects.