直接经皮冠状动脉介入治疗前即刻应用大剂量阿托伐他汀对心肌再灌注损伤和心功能的影响

The effect of loading dose atorvastatin administration shortly before P-PCI on myocardial reperfusion and cardiac function

目的探讨直接经皮冠状动脉介入治疗(PPCI)前超短期(1～2h)应用大剂量阿托伐他汀(80mg)对急性ST段抬高心肌梗死(STEMI)患者心肌缺血/再灌注损伤(I/R)的作用及短期预后的影响。方法入选85例行PPCI的STEMI患者,按照随机数字表法分为两组,他汀组(再灌注前1～2h给予阿托伐他汀80mg)36例和对照组49例。测定发病后CK-MB、cTnT峰值和达峰时间。于血管再通后测定TIMI血流分级(TFG)、TIMI血流帧数计数(TFC)和校正的TFC(CTFC)以及心肌呈色分级(MBG)。分别于入心内科重症监护病房(CCU)后第1天及发病后1个月行超声心动图检查(UCG),应用Simpson's法测定左心室射血分数(LVEF)。试验主要终点为30天主要不良心血管事件的发生。结果两组患者基础资料差异无统计学意义。与对照组相比,他汀组的CK-MB峰值降低,差异具有统计学意义[(252.11±206.13)U/L比(345.88±242.51)U/L,t=1.922,P=0.047]。两组患者入院UCG检查各项指标差异均无统计学意义,他汀组与对照组相比1个月时LVEF升高,但差异无统计学意义(0.62比0.58,t=-1.907,P=0.050)。结论 PPCI前超短期应用大剂量阿托伐他汀可以减轻心肌缺血再灌注损伤。阿托伐他汀预处理有可能改善急性心肌梗死(AMI)患者心功能。

Objective To explore the effect of loading dose atorvastatin administration shortly （1-2 h） before primary percutaneous coronary intervention （P-PCI） on myocardial ischemical reperfusion （I/R） injury and short-term prognosis in patients with STEMI. Methods Eighty five patients with acute ST-segment elevation myocardial infarction （STEMI） who underwent primary percutaneous coronary intervention （P-PCI） were selected. They were randomly assigned into two groups： the statin group who received atorvastatin with a loading dose of 80mg about 1-2 h before reperfusion （n=36） and the control group （n=49）. The peak value and the time to the peak of CKMB and cTnT were recorded. The Thrombolysis In Myocardial Infarction flow grades （TFG）, the TIMI frame count （TFC） and corrected TFC（CTFC） and myocardial blush grades （MBG） were determined after the vascular recanalization. The ultrasound cardiogram （UCG） examination were taken on the first day in cardiac care unit （CCU） and one month later, using Simpson′s method to measure the left ventricular ejection fraction （LVEF）. The primary end point of this trial is the incidence of main reverse cardiovascular events in 30 days. Results The baseline characteristics between the two groups showed no statistical significance（P0.05）. Compared with the control group, the CKMB peak value was lower in the statin group （252.11±206.13 U/L vs. 345.88±242.51 U/L,t=1.922, P=0.047）. There was no significant difference between the two groups in the UCG parameters which was performed on admission. The LVEF at one month was higher in the statin group than that in the control group, but there was no significant difference （0.62 vs. 0.58,t=-1.907, P=0.050）. Conclusions The administration of loading dose of atorvastatin shortly before P-PCI can reduce the ischemical reperfusion （I/R） injury. Atorvastatin pretreatment may improve the cardiac function of AMI patients.