不同剂量阿托伐他汀对急性冠脉综合征患者介入治疗围术期疗效及安全性的观察

Efficacy and safety of different doses of atorvastatin in ACS patients with PCI preoperative

目的:探讨国人急性冠脉综合征(ACS)患者经皮冠脉介入(PCI)治疗围术期40mg阿托伐他汀强化治疗的疗效及安全性。方法:采用随机对照研究方法,100例ACS患者随机分为A、B两组。A组50例给予阿托伐他汀20mg/d,B组50例给予阿托伐他汀40mg/d。于PCI术前、术后24h测定肌钙蛋白I(cTnI);PCI术前、术后5d、术后30d测定肌酸激酶(CK)、丙氨酸氨基转移酶(ALT)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)。观察ACS患者随访1个月期间主要心血管事件的发生情况。结果:(1)两组PCI术后24h cTnI均显著升高(P<0.01),A组较B组升高幅度差异有统计学意义(P<0.05)。(2)两组在用药后5d及30d LDL-C和TC均显著下降(P<0.01),40mg组下降幅度更加显著且30d LDL-C达标率(即LDL-C≤1.8mmol/L比例)更高(24%vs66%,P<0.01)。(3)A组30d主要心血管事件(心力衰竭2例)较A组(再发心肌梗死1例、心力衰竭5例、再发心绞痛需住院治疗3例共9例)显著降低(P<0.05)。(4)两组药物副作用差异无显著性(P>0.05)。结论:ACS患者PCI围手术期阿托伐他汀40mg/d能显著降低LDL-C、TC、cTnI水平,提高30d LDL-C达标率,降低围手术期主要心血管事件发生率。

Objective To study the efficacy and safety of different doses of atorvastatin on lowering intensive lipid in acute coronary syndrome （ACS） patients with percutaneous coronary intervention （PCI） during the preoperative period. Methods A randomized control study was used： 100 patients with ACS were selected randomly divided into two groups. 20 mg group, 50 patients were given doses of atorvastatin 20 mg/d. 40 tag group, 50 patients were given doses of atorvastatin 40 mg/d. Treatment time lasted for 1 month from before PCI to after PCI. cTnI of the blood samples were detected at the day before PCI , 24 h after PCI, 5 days （D） and 30 days （D） after PCI. Results （1） cTnI of two groups increased 24 h after PCI （P 〈 0.01）, and the cTuI of the 20 mg group increased more obviously than that of the 40 mg group （P 〈 0.05）. （2） After treatment, LDL-C and TC of two groups at 5D and 30D after atorvastatin treatment were significantly lower than those before treatment （P 〈 0.01）. At each time point after treatment, LDL-C and TC decreased more significantly in 40 mg group than in 20 mg group, the difference was statistically significant （P 〈 0.05）. Atorvastatin for one month, the compliance rate of LDL-C（LDL-C ~〈 1.8 retool/L） in 40 mg group was higher than 20 mg group （24% vs 66%, P 〈 0.01）. （3） Comparing with the 20 mg group, major cardiovascular events including repeated ischemic anginal attack requiring hospitalization, again myocardial infarction, heart failure, cardiac death in 40 mg group was significantly lower （P 〈 0.05）. （4） There is no significant difference in side effects between two groups （P 〉 0.05）. Conclusions Atorvastatin 40 rag used in ACS patients with preoperative PCI significantly reduced LDL-C, TC, cTnI level, and improved LDL-C success rate, reduced preoperative major cardiovascular events.