阿托伐他汀减少冠脉介入治疗引起心肌损伤及炎性反应的临床观察

Observation of atorvastatin in the reduction of myocardial injury and inflammatory response during percutaneous coronary intervention

目的 探讨经皮冠状动脉介入治疗（PCI）前预防性给予阿托伐他汀能否减轻PCI相关炎症反应及心肌损伤.方法 78例拟行PCI的不稳定型心绞痛患者随机分为阿托伐他汀预治疗组（42例）和对照组（36例）.治疗组在PCI前接受7 d的阿托伐他汀40 mg/d治疗;对照组在PCI前不使用他汀类药物.两组患者均接受其他常规治疗,且在PCI后均接受他汀类药物治疗.在术前和术后24 h检测超敏C反应蛋白（hs-CRP）、髓过氧化物酶（MPO）、肌钙蛋白I型（cTnI）,并记录围术期心肌梗死的发生率.结果 治疗组和对照组术后hs-CRP、MPO和cTnI与术前比较均显著升高（t＝8.2707、3.5621、2.6705比3.1671、3.8826、2.4049,P＜0.01或P＜0.05）;治疗组术前和术后的hs-CRP、MPO和cTnI均较对照组低（t＝3.3525、2.1587、2.8529比3.1171、2.7133、2.0915,P＜0.01或P＜0.05）.治疗组的围术期心肌梗死发生率显著低于对照组（χ2＝4.3858,P＜0.05）.结论 PCI前给予阿托伐他汀40 mg/d预防性7 d治疗,可以显著减少PCI造成的炎症反应及心肌损伤,对心肌有保护作用,安全性好.

Objective To investigate of atorvastatin in the reduction of myocardial injury and inflammatory response during the percutaneous coronary intervention （PCI） by pre-treatment. Methods 78 patients scheduled for PCI for unstable angina were randomly assigned to atorvastatin pre-treatment group （42 cases） and control group （36 cases）. The treatment group received atorvastatin 40 mg/d for 7 days before PCI treatment, the control group before PCI did not use statins. All patients received other conventional treatments, and accepted statin thera- py in the post-PCI. High sensitivity C-reactive protein （hs-CRP）, myeloperoxidase （MPO）, cardiac troponin I （cTnI） was tested in 24 h before and after surgery, and record the incidence of myocardial infarction in the perioperative. Results The hs-CRP, MPO, cTnI after surgery in the treatment group and the control group increased significantly compared with preoperative （t=8.2707, 3.5621, 2.6705 and 3.1671, 3.8826, 2.4049, P〈0.01 or P〈 0.05 ）. The hs-CRP, MPO, cTnl of preoperative and postoperative in the treatment group was significantly lower than control group （t=3.3525, 2.1587, 2.8529 and 3.1171, 2.7133, 2.0915, P〈0.01 or P〈0.05）. The incidence of myocardial infarction of the treatment group in the perioperative was significantly lower than the control group （X2=4.3858, P〈0.05 ）. Conclusion It can significantly reduce the inflammation caused by PCI and myocardial injury that given atorvastatin 40 mg/d 7 days preventive treatment before PCI, and it is security.