早期阿托伐他汀强化治疗对急性冠脉综合征患者PCI术后预后的影响

Clinical study of early application of intensive atorvastatin in patients with acute coronary syndrome underwent percutaneous coronary intervention

目的探讨早期阿托伐他汀强化治疗对急性冠脉综合征（ACS）患者行经皮冠状动脉介入治疗（PCI）后中远期预后的影响。方法选择2008年1月~2011年1月于该院住院行择期PCI术的ACS患者136例为研究对象。随机分为试验组和对照组,每组68例。试验组患者在术前12 h服用阿托伐他汀80 mg,此后80mg/d,连续服用6个月。对照组在术前12 h服用阿托伐他汀20 mg,此后20 mg/d,连续服用6个月。于PCI术前、术后3个月、6个月测定两组患者的血脂、肝肾功能,并通过电话或门诊随访两组患者有无出现主要不良心脏事件。结果 PCI术后3个月、6个月时,两组患者的TC、TG和LDL-C水平均呈逐渐下降趋势,HDL-C水平呈逐渐升高趋势,与术前基数值相比,差异均具有显著性（P〈0.05）。两组间比较,术后3个月、6个月试验组TC、TG和LDL-C水平下降幅度显著高于对照组（P〈0.05）,而HDL-C水平升高幅度显著高于对照组（P〈0.05）。两组患者均随访1年,试验组患者主要心脏不良事件发生率明显低于对照组（P〈0.01）。两组患者药物常见的不良反应发生情况比较,差异无显著性（均P〉0.05）。结论早期强化剂量的阿托伐他汀（60 mg/d）能著降低ACS患者PCI术后不良心脏事件的发生率,使ACS患者获益,且不良反应发生率低,安全性高。

【Objective】 To explore the prognosis effect of early application of intensive atorvastatin in patients with acute coronary syndrome by emergency percutaneous coronary intervention（PCI）.【Methods】 From January,2008 to January,2011,136 patients underwent ACS in our institution were involved in this study.All patients received PCI were randomly divided into experimental group and control group.There were 68 cases in each group,the patients in experimental group received oral atorvastain 80 mg,12 hour before operation,and 80 mg/d,for 6 month after operation.The patients in control group received oral atorvastain 20 mg,12 hour before operation,and 20 mg/d,for 6 month after operation.Before operation,3 and 6 months after PCI,peripheral blood samples were collected for lipid level analysis described with four type lipoprotein（TC,TG,LDL-C and HDL-C）.Adverse reactions including gastrointestinal reaction,fatigue,myalgia,rash and so on were followed up during treatment.Major adverse cardiac events（MACE） were followed up with phone,mail or at out-patient agency.【Results】 The primitive lipid level before therapy,described as base line,was equal in two groups.At 3,6 months after operation,TC,TG and LDL-C decreased and HDL-C increased in the both groups compared to the base line and there were significantly differences of TC,TG,LDL-C and HDL-C between two groups（P 0.05）.After one year follow up,major adverse cardiac events in experimental group were lower than that in control group（P 0.01）.After regular full length medicine therapy,no difference on adverse effects was found in two groups（P 0.05）.【Conclusions】 Early application of intensive atorvastatin could reduce the risk of major adverse cardiac events after PCI and make benefits for the patients with ACS.The use of high dose atorvastatin is safety.