瑞舒伐他汀强化治疗对心肌梗死患者经皮冠状动脉介入术后脂联素和脑钠肽及左心室重构的影响

Effect of intensive rosuvastatin on adiponection, brain natriuretic peptide and left ventricular remodeling after myocardial infarction with percutanious coronary intervention

目的探讨瑞舒伐他汀强化治疗对心肌梗死患者经皮冠状动脉介入（PCI）术后脂联素和脑钠肽及左心室重构的影响及机制。方法将2011年1月至2012年12月于滨州市人民医院就诊的96例急性心肌梗死早期行PCI术后合并心力衰竭患者完全随机分为对照组、治疗组和强化组，各32例。3组均给予常规治疗；治疗组术前1周加用瑞舒伐他汀10mg／d；强化组术前1周加用瑞舒伐他汀20mg／d。术后第1天及第4、8周空腹采取静脉血检测脂联素和脑钠肽浓度。术前及术后第8周采用彩色多普勒超声仪分别在左心室长轴切面、心尖四腔心、心尖五腔心测定左心室重构指标，包括左心室舒张末期内经（LVEDD）、左心室后壁厚度（LVPWT）、左心室射血分数（LVEF）、左心室质量指数（LVMI）、舒张期室间隔厚度（IVST）、E峰／A峰比值及室壁运动积分指数（WMSI）。记录住院期间及院外不良事件的发生情况。结果@PCI术后第1天、第4周及第8周3组患者血浆中脂联素水平均较术前明显升高[对照组：（5．9±1．5）、（7．1±1．4）、（8．2±1．3）g/L比（3．9±1．2）g/L；治疗组：（5．7±1．4）、（8．3±1．5）、（9．6±1．2）g／L比（4．1±1．0）g/L；强化组：（5．8±1．0）、（9．9±1．7）、（11．5±1．1）g/L比（4．3±0．9）g／L]（均P〈0．05）。术后第4、8周强化组血浆中脂联素水平均明显高于同期治疗组和对照组（均P〈0．05）。②PCI术后第1天、第4周及第8周，3组患者血浆中脑钠肽水平均较术前明显降低[对照组：（636±99）、（547±124）、（467±112）ug/L比（746±102）ug／L；治疗组：（676±107）、（436±89）、（401±91）ug/L比（730±142）ug／L；强化组：（607±131）、（346±67）、（286±72）ug/L比（738±127）ug/L]（均P〈0．05）。术后第4、8周强化组血浆中脑钠肽水平均明显低于同期治疗组和对照组（均P〈0．05）。③PCI术后第8周LVEDD、LVPWT、LVMI、WMSI均较术前明显降低（均P〈0．05），LVEF、IVST、E峰／A峰比值均较术前明显升高（均P〈0．05）。术后第8周强化组LVEDD、LVPWT、LVMI、WMSI均低于同期治疗组和对照组（均P〈0．05），LVEF、IVST、E峰／A峰比值均高于同期治疗组和对照组（均P〈0．05）。观察周期内强化组死亡1例，治疗组死亡2例，对照组死亡2例，3组病死率差异无统计学意义（P〉0．05）。结论瑞舒伐他汀强化治疗可明显升高PCI术后患者血浆中脂联素水平，从而保护冠状动脉血管内皮细胞，效果优于瑞舒伐他汀普通剂量治疗。瑞舒伐他汀强化治疗在左心室重构方面明显于瑞舒伐他汀普通剂量治疗。急性心肌梗死患者早期PCI基础上尽早应用瑞舒伐他汀强化治疗可明显降低冠心病患者PCI术后心血管事件发生率，同时瑞舒伐他汀安全，未见明显不良反应。

Objective To explore the effect of rosuvastatin intensive treatment on adiponectin, brain natfiuretic peptide and left ventricular remodeling after myocardial infarction with percutanious coronary intervention （PCI）. Methods Ninety-six patients with acute myocardial infarction undergoing PCI with heart failure were selected. All 96 cases were randomly divided into control group which was treated with general therapy ; the treatment group undertook rosuvastatin 10 mg/d on the basis of the general treatment; the intensive group was treated with rosuvastatin 20 mg/d based on the general treatment （32 cases in each group）. The adiponectin and brain natriuretic peptide were detected on the first day, four weeks and eight weeks after surgery. Color Doppler with left ventricular remodeling indicators, including the left ventricular end-diastolic diameter（ LVEDD）, left ventricular posterior wall thickness （LVPWT）, left ventricular ejection fraction （LVEF）, left ventricular mass index （LVMI） , diastolic interventricular septum thickness （IVST）, peak E and A wave ratio and wall motion score index （WMSI） were observed. The occurrence of adverse events in hospital and outside the hospital was recorded. Results （1）After therapy, the plasma adiponeetin was significantly higher than that before surgery [ control group ： （ 5.9 ± 1.5 ）, （7.1 ±1.4）,（8.2±1.3）g/L vs （3.9± 1.2）g/L; treatment group： （5.7 ± 1.4）,（8.3 ± 1.5）,（9.6 ± 1.2）g/L vs （4.1±1.0）g/L;intensivegroup：（5.8±1.0）,（9.9±1.7）,（11.5±1.1） g/Lvs（4.3±0.9）g/L] （P〈 0.05 ）. Four weeks and eight weeks after therapy, compared with statin treatment and control groups, plasma adiponectin levels in intensive group were significantly increased （ P 〈 0.05 ）. （2）After PCI, the plasma brain natriuretic peptide was significantly lower [control group： （636± 99）, （547 ± 124）, （467 ± 112） ug/L vs （746 ± 102）ug/L;treatment group： （676 ± 107）, （436 ± 89）, （401 ± 91 ） ug/L vs （730 ± 142 ） ug/L; intensive group： （607 ±131）,（346 ±67）, （286 ±72）la,g/L vs （738 ± 127）ug/L] （P 〈0.05）. After four weeks and eight weeks, plasma brain natriuretie peptide in intensive group was significantly lower （ P 〈 0.05 ）. （3）8 weeks after PCI, LVEDD LVPWT, LVMI and WMSI were signifieantly lower （P 〈 0.05 ）, while the LVEF, IVST and the E peak/A peak were significantly higher （P 〈 0.05）. 8 weeks after therapy, LVEDD, LVPWT and LVMI WMSI in intensive group were decreased （P 〈 0.05 ） ; LVEF, IVST, E peak/A peak were increased （ P 〈 0.05 ）. There were no significant differences in the rate of mortality （ P 〉 0.05 ）. Conclusions （1）Rosuvastatin stain intensive treatment can significantly increase plasma adiponectin levels and reduce plasma brain natriuretie peptide levels, tt protects the coronary vaseular endothelial cells and reduce the oecurrence of in-stent restenosis. （2）Rosuvastatin intensive treatment is effective on left ventrieular remodeling. （3） Aeute myocardial infarction in patients with early PCI on the basis of early application of rosuvastatin intensive treatment can significantly reduce PCI postoperative cardiovascular events in patients with coronary heart disease.