单次负荷量他汀对稳定型心绞痛患者PCI术后炎症反应、血小板活性及心脏事件的影响

Effect of preoperative single intensive statin on postoperative serum inflammation factors,platelet activity and major adverse cardiac events in stable angina patients after percutaneous coronary intervention

目的观察已接受长期他汀治疗的稳定型心绞痛患者,经皮冠状动脉介入术(percutaneous coronary interven-tion,PCI)前单次服用80 mg阿托伐他汀能否降低术后炎症反应、血小板活性以及主要不良心脏事件(major adverse cardiacevents,MACE)的发生。方法选择2010年1月至2011年7月在本科接受PCI术的稳定型心绞痛患者115例,年龄(59.23±10.23)岁,男性83例,女性32例。随机分为2组:强化组(n=56)在PCI术前12 h给予单次负荷剂量(80 mg)阿托伐他汀;对照组(n=59)在PCI术前12 h予常规剂量(20 mg)阿托伐他汀治疗。观察2组患者术前24 h及术后24 h血白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、高敏C反应蛋白(hs-CRP)及血小板α颗粒膜蛋白(GMP140)、p-选择素(CD62p)水平,并随访所有患者术后30 d内MACE的发生情况。结果 2组术前24 h各指标无差异(P>0.05)。强化组术后24 h炎症因子及血小板活化因子显著低于对照组(P<0.05);强化组炎症因子及血小板活化因子水平在PCI术后较术前显著下降(P<0.05)。对照组术后较术前有一定程度的升高(P>0.05);术后30 d强化组MACE发生率显著低于对照组(P<0.05)。结论对于已接受长期他汀治疗的稳定型心绞痛患者,PCI术前12 h再给予单次80 mg阿托伐他汀能显著降低炎症因子、血小板活化因子及MACE的发生。

Objective To investigate whether a single loading of 80 mg atorvastatin before receiving percutaneous coronary intervention （PCI） can reduce postoperative inflammation, platelet activity and incidence of major adverse cardiac events （MACE） in stable angina patients who had accepted a long-term statin therapy. Methods One hundred and fifteen patients with chronic stable angina who underwent PCI in our department from Jan. 2010 to Jul. 2011 were prospectively selected. The patients were divided into the intensive statin group （ a single loading of 80 mg atorvastatin in 12 h before receiving PCI） and the standard group （ a routinedosage of 20 mg atorvastatin at same time point）. Serum levels of interleukin-6 （IL-6）, high sensitivity C-reac- tive protein（ hs-CRP）, tumor necrosis factor-or （TNF-cO, GMP140 and p-selectin （CD62p） were measured in 24 h before and 24 h after PCI in all patients. The incidence of MACE was observed in 30d after surgery. Results The basic clinical data and PCI basic characteristics between the two groups showed no obvious difference （ P 〉 0. 05 ）. When compared with those in the standard group, the levels of inflammation and platelet activation factors were lower in the intensive statin group after 24 h （P 〈 0. 05 ）. The levels of inflammation and platelet activation factors at 24 h after PCI were lower than before PCI in the intensive statin group （ P 〈 0. 05）. While the levels of inflammation and platelet activation factors at 24 h after PCI showed a rising trend than before PCI in the standard group（ P 〉 0. 05 ）. The incidence of MACE in the intensive group was lower than that in the standard group（P 〈 0. 05）. Conclusion Before receiving PCI, a single loading of 80 mg atorvastatin reduces inflammation , platelet activity and incidence of MACE in patients with stable angina who had accepted the long-term statins therapy.