负荷量加高维持量的阿托伐他汀对急性冠脉综合征患者介入治疗后血管内皮功能、血小板活化和炎症因子及预后的影响

Effects of High Loading Dose and High Maintenance Doses of Atorvastatin on Platelet Activity,Vascular Endothelium Function,Inflammation and Prognosis in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention

目的探讨负荷量加高维持量的阿托伐他汀对急性冠脉综合征(ACS)患者介入治疗后血管内皮功能、血小板活化和炎症因子以及预后的影响。方法 100例ACS患者随机分为负荷量阿托伐他汀治疗组(负荷量组50例)和常规剂量组(常规量组50例)。常规量组在PCI术后给予阿司匹林、氯比格雷、β-受体阻滞剂、阿托伐他汀(每晚20 mg)、血管紧张素转化酶抑制剂等治疗4周。负荷量组在PCI术前于常规治疗基础上加用阿托伐他汀负荷剂量80mg,然后给予40 mg维持剂量治疗4周,4周后继续给予20 mg维持,与对照组进行比较。两组患者在PCI术前和术后次日、术后7 d和治疗4周后清晨分别空腹抽取肘静脉血用流式细胞仪测定血小板活化指标CD62p和糖蛋白(GP)Ⅱb/Ⅲa受体复合物的水平;测定反映血管内皮功能的血浆血管性假血友病因子(vWF),内皮素1(ET-1)和一氧化氮(NO)的水平;用乳胶免疫增强比浊法测定血清高敏C反应蛋白(hs-CRP)的水平。并选择健康体检者40例作对照组。比较两组心血管事件发生率。结果 ACS患者PCI前CD62p、GPⅡb/Ⅲa、vWF、ET-1、NO及hs-CRP水平与对照组比较,差异均有统计学意义(P<0.05)。ACS患者PCI后CD62p、GPⅡb/Ⅲa、vWF和hs-CRP水平与PCI前比较,差异均有统计学意义(P<0.05)。常规量组和负荷量组治疗7 d和4周后,ACS患者的血小板活化指标CD62p、GPⅡb/Ⅲa、vWF、ET-1、NO及hs-CRP水平间差异均有统计学意义(P<0.05)。两组PCI治疗4周后EF与治疗前比较,差异均有统计学意义(P<0.05);且PCI治疗4周后两组EF间差异有统计学意义(P<0.05)。两组PCI后1年心血管事件和再狭窄发生率间差异均有统计学意义(P<0.05)。结论负荷量加高维持量的阿托伐他汀可以进一步抑制ACS患者PCI术后血小板活化和炎症反应,改善血管内皮功能和心功能,减少心血管事件。

Objective To observe the effects of high loading dose and high maintenance dose of atorvastatin on platelet activity, vascular endothelium function, and inflammation as well as prognosis in patients with acute coronary syndrome undergo- ing percutaneous coronary intervention （PCI）. Methods Totally 100 patients with acute coronary syndrome were randomly di- vided into high loading doses of atorvastatin treatment group （ atorvastatin group） （ n = 50 ） and conventional treatment group （conventional group） （n =50）. Another 50 healthy people were enrolled as the control group. Blood CD62p, glucose protein （GP） Ⅱ b/Ⅲa and endothelium 1 （ ET - 1 ）, yon Willebrand factor （ vWF）, nitric oxide （NO） levels, and high sensitivity C -reactive protein （hs -CRP） were measured before treatment and the second day after PCI. Then, the patients in atorvastatin group received high loading doses （80 mg） and maintenance dose （40 mg, QN） of atorvastatin for 4 weeks, and the results were compared with the conventional group. Results Compared with healthy control group, the blood CD62p, GPⅡ b/Ⅲ a, vWF, ET - 1, and hs - CRP levels increased significantly in ACS patients （ all P 〈 0. 01 ） and NO significantly decreased （ P 〈 0. 01 ）. Among the ACS patients, plasma levels of vWF increased significantly （ P 〈 0. 05 ） and CD62p and GPⅡb/Ⅲ a de- creased significantly （P 〈 0. 05） after PCI. In both atorvastatin group and convention group, the plasma levels of CD62p, GP Ⅱ b/Ⅲa, vWF, ET - 1, and hs - CRP decreased significantly （P 〈0. 05, P 〈0. 01 ） compared with the pre - treatment levels, and meanwhile all these parameters were different significantly between atorvastatin group and conventional group （P 〈 0. 01, P〈 0. 05 ）. In addition, the parameter above showed significantly differences after treatment of 4 weeks than 7 days （P 〈 0. 01 or P 〈 0.05 ） The left ventricular ejective fraction （EF） value of the two groups significantly increased after 4 weeks of treatment （P 〈0. 05, P 〈0. 01 ）, whereas the EF value in load group increased more than that in conventional group. There were 2 cases of sudden death, 7 cases of recurrent angina, and 3 cases of ventricular tachycardiac （VT） /ventricular fibrillation （VF） in conventional group after 4 weeks ; on the contrary, there were one case of recurrent angina and one case of heart failure but with- out VT/VF and sudden death occurred in the atorvastatin group after 4 weeks. Conehmion High loading doses of atorvastatin cao inhibit the platelet activity and vascular inflammation, protect the vascular endothelium function, improve heart function, and decrease incidence of major cardiovascular events （MACE） after PCI.