阿托伐他汀对急性心肌梗死介入治疗患者血浆非对称性二甲基精氨酸浓度的作用

Effect of atorvastatin on plasma concentration of asymmetric dimethylarginine in acute myocardial infarction patients undergone direct percutaneous coronary intervention

目的观察急性心肌梗死直接经皮冠状动脉介入治疗(PCI)患者血浆非对称性二甲基精氨酸(Asymmetric Dimethylarginine,ADMA)浓度的变化及阿托伐他汀对其影响。方法本实验入选了27例正常冠状动脉者(对照组)和63例急性ST段抬高型心肌梗死患者(STEMI组)。根据服用阿托伐他汀的剂量不同,将STEMI患者分为常规剂量组(术前服用阿托伐他汀20mg,继以20mg,1次/晚,至出院后30d)和大剂量组(术前服用阿托伐他汀80mg,继以40mg,1次/晚,至出院后30d)。所有对象于入院后取静脉血,STEMI患者术后第3天时再次取静脉血,用于血浆ADMA浓度的测定。结果 (1)STEMI组患者血浆ADMA浓度术前和术后3d时分别为(1.36±0.34)μmol/L和(1.74±0.30)μmol/L,均较对照组(0.78±0.18)μmol/L升高。(2)STEMI组患者血浆ADMA浓度在PCI术后3d时较术前升高,分别为(1.74±0.30)μmol/L和(1.36±0.34)μmol/L。(3)STEMI患者不同剂量组间血浆ADMA浓度术后3d时,大剂量组低于常规剂量组,分别为(1.59±0.27)μmol/L和(1.80±0.30)μmol/L。结论 STEMI患者血浆ADMA浓度升高,且在PCI术后3d时继续升高,提示冠状动脉内皮功能受损。在STEMI患者PCI围术期服用大剂量阿托伐他汀较常规剂量可抑制血浆ADMA的升高,提示发挥内皮保护作用。

Objective To observe changes in plasma concentration of asymmetric dimethylarginine（ADMA） in acute myocardial infarction patients undergone direct percutaneous coronary intervention（PCI）,and to observe the effect of atorvastatin on the change of plasma concentration of ADMA.Methods Twenty-seven normal people（the control group） and sixty-three acute ST-segment elevated myocardial infarction（STEMI） patients（the STEMI group） were enrolled.The STEMI patients were treated with lower-dose atorvastatin（lower-dose group,n=32,20 mg before PCI,then 20 mg QN till 30 days after patients＇ discharge） or high-dose atorvastatin（high-dose group,n=31,80 mg before PCI,then 40 mg QN till 30 days after patients＇ discharge）.Venous blood was drawn at admission and 3 days after the operation to measure the concentration of plasma ADMA.Results（1）STEMI patients＇ plasma concentrations of ADMA before and 3 days after PCI were（1.36±0.34）μmol/L and（1.74±0.30） μmol/L respectively,and both were higher than that of normal control group（0.78±0.18 μmol/L）.（2）STEMI patients＇ plasma concentration of ADMA 3 days after PCI increased compared to that before PCI [（1.74±0.30） μmol/L vs.（1.36±0.34） μmol/L].（3） Plasma concentration of ADMA of high-dose group was lower than that of the lower-dose group 3 days after PCI [（1.59±0.27） μmol/L vs.（1.80±0.30） μmol/L].Conclusions Plasma concentration of ADMA in STEMI patients elevates till at least 3 days after PCI,which indicates endothelial damage of coronary artery might be serious.Compared with low-dose atorvastatin therapy,high-dose atorvastatin can repress the elevation of plasma ADMA during PCI perioperative period in STEMI patients,which indicates high-dose atorvastatin therapy might protect the blood vessel endothelium of coronary artery.