不同剂量阿托伐他汀在冠脉介入治疗围手术期的应用研究

Application of different doses of atorvastatin in percutaneous coronary intervention treatment during perioperative period

目的:探讨不同剂量的阿托伐他汀在经皮冠脉介入治疗(PCI)围手术期应用的价值。方法:120例拟行(PCI)的冠心病(CHD)患者随机分为对照组(A组)、低剂量干预治疗组(B组)和中等剂量干预治疗组(C组)。A组术前不服用阿托伐他汀,B和C组术前分别服用20mg或40mg阿托伐他汀7d,3组患者术后均用阿托伐他汀20mg/d维持治疗。术前、术后24h及术后1月后监测CK-MB、C反应蛋白、肌钙蛋白I、血肌酐。结果:(1)PCI术后24hCK-MB、C反应蛋白较术前均有升高,A组与B、C组差异有统计学意义(P<0.05),B和C组间差异无统计学意义(P>0.05),术后1月A组CK-MB、C反应蛋白与B组、C组差异有统计学意义(P<0.05);(2)B、C组患者围手术期MI发生率较A组低,但差异无统计学意义(P>0.05);(3)3组患者血肌酐的变化差异均无统计学意义(均P>0.05)。结论:PCI术后CK-MB、C反应蛋白水平升高,提示存在一定的PCI术相关性心肌损伤;PCI术前阿托伐他汀干预治疗7天也可以在一定程度抑制PCI相关心肌损害,未显示有肾保护作用。

Objective： To evaluate the value of different doses of atorvastatin in percutaneous coronary intervention（PCI） treatment during perioperative period.Methods： A total of 120 CHD patients scheduled for PCI treatment were randomly divided into control group（group A）,low-dose intervention group（group B） and middle-dose intervention group（group C）.Group A didn＇t take atorvastatin during perioperative period,while group B and C took atorvastatin at does of 20 and 40 mg,respectively for 7 days before undergoing the surgery.All the three groups were given postoperative atorvastatin 20 mg/d as maintenance therapy.Monitor CK-MB,C-reactive protein,troponin I,and serum creatinine 24 hours before and after the surgery as well as 1 month after the surgery.Results：（1） The CK-MB,C-reactive protein increased 24 hours after the PCI treatment in all groups,but the increase was significantly different in group A than that in group B and C（P0.05）,significant difference in increases of CK-MB,C-reactive protein was observed between group B and C 1 month after the surgery（P0.05）,though no similar result was shown before（P0.05）.（2） Group B and C showed lower incidence of perioperative MI was than group A,but the difference was not statistically significant（P 0.05）（3） Changes in serum creatinine level were not significant in all three groups（P0.05）.Conclusions： The postoperative increase of CK-MB,C-reactive protein suggests occurrence of PCI related myocardial damage;taking atorvastatin for 7 days before undergoing CPI treatment can inhibited this damage to some extent as well as produce renal protective effects.