不同剂量阿托伐他汀对急性心肌梗死患者血管内皮功能和炎症反应的影响

The effect of various doses of atorvastacin on vascular endothelial function and inflammation in patients with acute myocardial infarction

目的 观察不同剂量阿托伐他汀对急性心肌梗死患者血管内皮功能和炎症反应的影响.方法 选择46例急性心肌梗死患者,随机分为高剂量组和低剂量组.高剂量组采用阿托伐他汀40 mg,1次/d进行治疗,低剂量组采用阿托伐他汀20 mg,1次/d进行治疗.采用二维超声检测肱动脉内皮依赖性舒张功能、抗原特异性T细胞增殖反应及反应过程中产生的γ干扰素（IFN-γ）,以观察药物治疗对血管内皮功能及炎症反应的影响.结果 治疗后患者反应性充血像（低剂量组9.31±1.96,高剂量组16.77±1.98）比治疗前（低剂量组7.62±1.32,高剂量组7.70±0.73）显著提高,且高剂量组较低剂量组显著提高（P＝0.003,P＜0.05）.治疗后患者淋巴细胞刺激指数（低剂量组1.34±0.19,高剂量组1.02±0.13）比治疗前（低剂量组1.78±0.13,高剂量组1.89±0.14）显著降低,且高剂量组较低剂量组显著降低.治疗后IFN-γ（低剂量组23.09±3.45,高剂量组17.22±3.90）比治疗前（低剂量组30.24±3.14,高剂量组31.49±4.32）显著降低,且高剂量组较低剂量组显著降低（P＝0.009）.结论 阿托伐他汀对急性心肌梗死患者血管内皮功能和斑块稳定性改善明显,增加治疗剂量后,改善更加明显.

Objective To investigate the effect of different dosage of atorvastatin on endothelial function and inflammation in patients with acute myocardial infarction. Methods 46 Patients with acute myocardial infarc-tion were divided randomly into two groups, which were respectively given 40 mg/d atorvastatin as high dose group, 20 mg/d atorvastatin as low dose group. After that, Brachial artery uhrasonography, antigen specific T-cell proliferation reaction and the level of IFN-γ were performed to detect the vascular endothelial function and inflam-mation. Results FMD was significantly increased after treatment （7.70±0.73 vs. 16.77±1.98 in high dose group; 7.62±1.32 vs 9.31±1.96 in low dose group）, and patients in high dose group（16.77±1.98） were significantly high-er than those in low dose group （9.31 ±1.96）. On the contrary, SI was decreased significantly after treatments. The decrease in high dose group （1.02±0.13） was more significant than those in low dose group （1.34±0.19） （P〈 0.05 ）. Similarly, as compared with pre-treatment, a remarkable decrease of IFN-γ was detected （30.24±3.14 vs. 23.09±3.45 in low dose group, 31.49±4.32 vs 17.22±3.90 in high dose group）. The decrease in high dose group （17.22±3.90） was more significant than those in low dose group （23.09±3.45） （P〈0.05）. Conclusion Atorvas-tatin significantly improve the vascular endothelial function and atherosclerotic plaque stability in patients with a-cute myocardial infarction in a dose-dependent manner.