强化他汀类药物治疗对不稳定型心绞痛合并糖尿病患者经皮冠状动脉介入术后冠状动脉血流的影响

Effect of intensive atorvastatin therapy on coronary blood flow after percutaneous coronary intervention of unstable angina patients with diabetes

目的 探讨阿托伐他汀强化治疗对不稳定型心绞痛合并糖尿病患者经皮冠状动脉介入（PCI）治疗术后冠状动脉血流灌注及安全性的影响.方法 对我院2011年7月至2013年7月收治的合并糖尿病的不稳定型心绞痛患者137例行PCI治疗,随机分为强化组78例和常规组59例;两组患者入院后常规给予阿托伐他汀20 mg/d口服,强化组术前2h口服阿托伐他汀80 mg,常规组术前未用阿托伐他汀预处理.观察主要终点即术后即刻冠状动脉血流灌注及围手术期心肌梗死情况;安全终点即出院前肝功能、肌酸激酶及肾功能变化.结果 强化组患者术后无复流、慢血流及围手术期心肌梗死总体发生率5.1％ （4/78）较常规组17.0％ （10/59）相比减少,差异有统计学意义（x2=5.44,P=0.02）;而出院前,两组患者的肝功能、肌酸激酶及肾功能水平差异无统计学意义（P均＞0.05）.在多因素相关分析后发现,校正性别、年龄、吸烟、高脂血症、病变累及重要分支及后扩张等因素后,强化阿托伐他汀治疗仍是避免发生无复流、慢血流及围手术期心肌梗死的独立预测因子（OR =0.21,95％ CI为0.07 ～0.91,P=0.04）.结论 阿托伐他汀强化治疗可以改善合并糖尿病的不稳定型心绞痛患者PCI后冠状动脉血流灌注情况,且不增加不良反应的发生.

Objective To investigate the effect of intensive atorvastatin therapy on coronary reperfusion of patients with unstable angina and diabetes undergoing percutaneous coronary intervention （PCI） and its safety.Methods One hundred and thirty-seven unstable angina patients with diabetes were underwent percutaneous coronary intervention in Zhumadian Central Hospital from July 2011 to July 2013.Patients were randomly divided into regular and intensive groups.Patients in regular group （n =59） were received atorvastatin 20 mg/d after admission and in intensive group （n =78） were received atorvastatin 80 mg 2 h before PCI beside atorvastatin 20 mg/d.The information of thrombolysis in myocardial infarction flow grade and perioperative myocardial infarction（MI） were recorded.The level of liver enzyme,serum creatinine and creatine kinase were measured.Results Compared with the regular group,the postoperative incidence of no reflow,slow flow and perioperation MI was lower in intensive group.The rate of MI in intensive group was 5.1% （4/78）,lower than that in regular group （17.0% （10/59） ;x2 =5.44,P =0.02））.There was no significant difference in terms of liver enzymes,serum creatinine and creatine kinase between two groups （P 〉 0.05）.Multiple factors correlation analysis showed that after adjusted gender,age,smoking,hyperlipidemia,lesions and important branch after the involvement of expansion and other factors,intensive statin therapy was the independent prognostic factor to avoid the occurrence of no reflow,slow flow and peri operation period of myocardial infarction.Conclusion The intensive atorvastatin therapy can improve coronary perfusion without increasing the risk of side-effect for unstable angina patients with diabetes undergoing PCI.