大剂量阿托伐他汀对急性冠状动脉综合征患者经皮冠状动脉介入治疗围手术期心肌保护作用

The perioperative myocardial protection of high-dose atorvastatin to acute coronary syndrome patients during percutaneous coronary artery interventional therapy

目的观察大剂量阿托伐他汀对急性冠状动脉综合征（ACS）患者经皮冠状动脉介入治疗（PCI）围手术期的心肌保护作用。方法120例择期行PCI的ACS患者，按随机数字表法分为两组，每组60例，A组术前3d口服阿托伐他汀80mg／d，B组术前3d口服阿托伐他汀20mg／d。两组患者均于术前、术后6h、术后12h测定肌钙蛋白I（cTnI）、肌酸激酶同工酶MB（CK—MB）、超敏C反应蛋白（hs-CRP）、白细胞介素（IL）-6。于术前、术后3d测定总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C），并进行比较。结果两组术后6h及术后12hcTnI、CK．MB、hs．CRP、IL-6水平均明显高于术前，差异有统计学意义（P〈0．05）。术后6hA组cTnI、CK-MB水平明显低于B组[（0．35±0．18）μg／L比（0．48±0．16）μg／L，（3．78±0．45）μg／L比（4．56±0．55）μg／L]，术后12hA组hs-CRP、IL-6水平明显低于B组[（4．53±0．98）mg／L比（7．03±0．88）mg／L，（30．6±11．2）ng／L比（43．8±12．1）ng／L]，差异均有统计学意义（P〈0．05）。两组患者术前、术后TC、TG、LDL-C、HDL-C水平比较差异无统计学意义（P〉0．05）。结论择期行PCI患者术前3d口服阿托伐他汀80mg／d，其心肌保护作用优于口服阿托伐他汀20mg／d，可在临床应用。

Objective To observe the perioperative myocardial protection of high-dose atorvastatin to acute coronary syndrome（ACS） patients during percutaneous coronary artery interventional therapy （PC!）. Methods One hundred and twenty patients with ACS undergoing elective PCI were divided into group A and group B with different oral dose of atorvastatin （80 mg/d and 20 mg/d ） for 3 days before operation by random digits table. Troponin I （cTnI）, creatine kinase isozyme MB （CK-MB）, high sensitive C-reactive protein （hs-CRP）, interleukin （IL）-6 levels were measured before operation, 6 hours, 12 hours after operation and total cholesterol （TC）, triglyeride （TG）, low desity lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL-C） levels were measured before operation and 3 days after operation. Results cTnI,CK-MB,hs-CRP and IL-6 levels in the two groups were increased significantly 6 hours and 12 hours after operation （P 〈 0.05）. Six hours after operation, cTnI and CK-MB levels in group A were significantly lower than those in group B [ （0.35 ±0. 18） μg/L vs. （0.48 ± 0.16） μg/L, （3.78 ± 0.45 ） μg/L vs. （4.56 ± 0.55 ） μg/L] （P 〈 0.05 ）. Twelve hours after operation , hs-CRP and IL-6 levels in group A were significantly lower than those in group B [ （4.53 ± 0.98 ） mg/L vs. （7.03 ± 0.88 ） mg/L, （ 30.6± 11.2） ng/L vs. （43.8 ± 12.1） ng/L] （P 〈0.05）. TC, TG, LDL-C, HDL-C levels in the two groups did not change significantly before and after operation （P 〉 0.05）. Conclusions Myocardial protective effects of ACS patients treated with atorvastatin 80 mg/d for 3 days are better than those treated with oral atorvastatin 20 mg/d. High-dose atorvastatin can produce more beneficial effects.