强化他汀治疗对急性冠脉综合征行介入治疗患者的疗效与安全性

Curative effect and safety of intensive statin therapy in treatment of acute coronary syndrome after percutaneous coronary intervention

目的观察强化他汀治疗对于急性冠脉综合征（ACS）患者介入治疗术后的疗效及安全性。方法纳入2010年1月~2011年6月于中国医科大学第一附属医院心血管内接受介入治疗的ACS患者239例，随机分为常规治疗组（n=119）和强化治疗组（n=120）,常规治疗组予阿托伐他汀20 mg（qN），强化治疗组入院采血后即刻予阿托伐他汀80mg口服，后予阿托伐他汀40mg（qN）维持治疗。比较两组治疗前、治疗后第7天和治疗后1个月血脂[包括胆固醇（TC）、低密度脂蛋白（LDL-C）]、谷丙转氨酶（ALT）、肌酐（Cr）、高敏C反应蛋白（hs-CRP）、ADP诱导的血小板聚集率及治疗后1个月内主要心血管不良事件（MACE，包括心肌梗死后心绞痛、心力衰竭、再发心肌梗死、心源性死亡）。结果两组治疗后TC、LDL-C、hs-CRP均较治疗前下降，且随时间延长而下降，其中强化治疗组下降更为明显，两组间差异有统计学意义（P＜0.05）；但血浆ALT、Cr、血小板聚集率和氯吡格雷抵抗发生率无改变（P＞0.05）；强化治疗组心绞痛复发率和心力衰竭发生率低于常规治疗组（心绞痛：15.0%vs.26.9%；心力衰竭：9.2%vs.18.5%，P＜0.05），但两组再发心肌梗死及心源性死亡率无统计学差异（P＞0.05）。结论ACS患者接受介入治疗术后早期服用大剂量的阿托伐他汀可进一步降低血脂水平，减少不良心脏事件发生率，且不影响抗血小板药物的作用强度。

Objective To observe the curative effect and safety of intensive statin therapy in treatment of acute coronary syndrome （ACS） after percutaneous coronary intervention （PCI）. Methods The ACS patients （n=239） with PCI were chosen from Jan. 2010 to Jun. 2011, and then randomly divided into routine group （n=119） and intensive group （n=120） after collecting fast blood samples in the morning of the next day after hospitalization. The routine group was given atorvastatin （20 mg/qN） and intensive group was orally given atorvastatin （80 mg） immediately after blood samples collecting and then given atorvastatin （40 mg/qN） for maintenance treatment. The changes of blood fat （TC and LDL-C）, ALT, Cr, hs-CRP and platelet aggregation induced by ADP were compared between two groups before treatment and 7 days and one month after treatment. Results The levels of TC and LDL-C decreased in two groups after treatment and decreased as treatment time expansion, which was more significant in intensive group （P〈0.05）. There was no statistical difference in ALT, Cr, platelet aggregation and clopidogrel resistance between two groups （P〉0.05）. The recurrence rate of angina and incidence of heart failure were lower in intensive group than those in routine group （angina：26.9%vs. 15%;heart failure：18.5%vs. 9.2%, P〈0.05）. There was no statistical difference in relapse myocardial infarction and cardiac death between two groups （P〉0.05）. Conclusion Early taking high-dose atorvastatin can reduce the level of blood fat and incidence of major adverse cardiac events, and has no influence on antiplatelet drugs in ACS patients with PCI.