急性心肌梗死患者无复流现象与降低血浆胆固醇的临床观察

Clinical study about no-reflow phenomenon in patients with acute myocardial infarction and reduction in plasma cholesterol

目的观察服用他汀类药物对患者血浆总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)及发生急性心肌梗死后急诊经皮冠状动脉成形术(PCI)后发生无复流现象的影响。方法行急诊PCI的患者于冠状动脉抽血测TC定、LDL-C水平。将急诊开通梗死相关血管的161例患者依据PCI后有无复流分为,未使用他汀类药物复流(NSNN组,n=88)、未使用他汀类药物无复流(NSN组,n=19)、使用他汀类药物复流(SNN组,n=52)、使用他汀类药物无复流(SN组,n=2)。对各组复流发生情况、血浆TC、LDL-C水平数据进行分析。结果各组之间无复流现象发生率,NSNN组88例(54.7%);NSN组19例(11.8%);SNN组52例(32.3%);SN组2例(1.2%)。使用他汀治疗后发生无复流现象比例显著低于未使用他汀治疗组(P<0.05)。未发生复流现象组患者(NSNN、SNN)血浆TC及LDL-C水平显著低于发生无复流现象组患者(NSN、SN)(P<0.05或<0.01)。结论急性心肌梗死患者再灌注治疗后发生无复流现象可能和血脂水平有关。他汀类药物可以显著改善急性心肌梗死患者急诊再灌注治疗无复流现象的发生,其机制之一可能通过降低血浆胆固醇。同时血浆胆固醇及LDL-C低水平的患者发生无复流概率可能较小。

Objective This study aimed to investigate the effect of statins for plasma total cholesterol（TC） and low density lipoprotein-cholesterol（LDL-C）, no-reflow phenomenon in patients with acute myocardial infarction who underwent percutaneous coronary interventional（PCI） therapy. Methods The blood samples were taken from the coronary artery in emergency PCI patients to determine TC and LDL-C. The patients who had undergone PCI therapy successfully were assembled into four groups, without statins therapy and without no-reflow phenomenon （group NSNN, n = 88） ,without statins therapy and with no-fellow phenomenon （group NSN, n = 19）, with statins therapy and without no-reflow phenomenon （group SNN, n = 52） ,with statins therapy and with no-reflow phenomenon （group SN, n = 2）. The incidence of no-reflow and the plasma cholesterol, LDL-C were analyzed. Results No-reflow phenomenon occurred in 88 patients（54.7 % ） of group NSNN, 19 patients（11.8 % ） of group NSN ; 52 patients（32.3 % ） of group SNN and two patients（1.2 %） of group SN. The rate of no-fellow phenomenon in the patients treated with statins was significantly lower than that of the patients treated without statins （ P 〈 0.05 ）. In the patients （NSNN, SNN） of no-reflow phenomenon,the plasma TC and LDL-C were significantly lower than those patients without no- reflow phenomenon（ P〈0.01 or 〈 0.05）. Conclusion The no-reflow phenomenon may have related to plasma cholesterol and LDL-C in patients with acute myocardial infarction after emergency PCI therapy. Statins can decrease no-reflow phenomenon in patients with acute myocardial infarction when they undergo PCI therapy. The mechanism may partly due to the decreasing plasma TC and LDL-C. And it is interesting that the patients with lower plasma TC and LDL-C may suffer from no-reflow less.