强化阿托伐他汀治疗对稳定性冠心病患者经皮冠状动脉介入治疗效果的影响

The effect of intensive statin pretreatment on stable coronary atherosclerotic heart disease patients treated withpercutaneous coronary intervention

目的:探讨强化他汀治疗对稳定性冠心病患者经皮冠状动脉介入治疗(PCI)术后心肌灌注及心肌损伤、肾功能损伤的影响。方法:行择期PCI的稳定性冠心病患者154例,随机分为标准他汀组(n=76)和强化他汀组(n=78)。于PCI术前及PCI后记录TIMI血流、纠正的TIMI计帧数(CTFC)以及TIMI心肌灌注分级(TMPG)等。于PCI前后测量肌酸磷酸激酶同工酶MB(CK-MB)、肌钙蛋白T(TnT)、高敏C反应蛋白(hs-CRP)、血肌酐(SCr)水平。结果:强化他汀组支架置入后TIMI血流0～1级显著少于标准他汀组,3级显著多于标准他汀组(P<0.05)。强化他汀组无复流发生率显著低于标准他汀组(P<0.01)。CTFC在强化他汀组显著低于标准他汀组(P<0.05)。强化他汀组的TMPG也显著优于标准他汀组(P<0.05)。PCI术后24h,CK-MB和TnT在强化他汀组显著低于标准他汀组。在强化他汀组,PCI术后24h,hs-CRP水平显著低于标准他汀组(P<0.001),SCr水平与标准他汀组无差异(P>0.05)。结论:PCI术前使用强化他汀治疗比标准他汀治疗能有效改善患者的心肌灌注、减轻心肌损伤。同时伴有hs-CRP水平显著降低。

Objective To study the effect o f intensive statin pretreatment on stable coronary atherosclerotic heart disease patients treated with pereutaneous coronary inte rvention（PCI）, and probe into them echanisms. Methods：78 patients with stable coronary atherosclerotie heart disease were randomized to receive atorvastatin（20mg/d, standard statin group）or（60-80mg/d, intensive statin group ）after admition. TIMI grade flow （TGF）, corrected TIMI frame count （CTFC）and TIMI myocardial perfusion grade（TMPG）of the intervened vessel were recorded before and after PCI. Creatin kinase isoenzyme MB（CK-MB ）, troponin T and plasma level of high sensitivity C-reactive protein（hs-CRP）and serum ereatinine （SCr）were measured before and 24 hours after the procedure. Results： The TFG ,CTFC and TMPG after stent deployment was significantly improved in intensive statin group than those in standard statin group（P〈0.05）. Patients with no reflow phenomenon were less in intensive statin group （P〈0.01）. Twenty-four hours after the procedure, CK-MB,TnT and hs-CRP were significantly lower in intensive statin group. The level of SCr was no difference between two groups. Conclusions：Intensive statin pretreatment before PC1 can further improve myocardial blood perfusion, protect myocardium from ischemie injury.This benefitis associated with the lowering of hs-CRP, TnT.