替罗非班联合大剂量他汀治疗急性心肌梗塞的疗效及安全性

Therapeutic effect and safety of tirofiban combined large dose statin in patients with acute myocardial infarction

目的：观察和分析替罗非班联合大剂量他汀治疗急性心肌梗死（AMI）的疗效及安全性，评价其对心肌灌注及心脏功能的影响。方法：2011年5月至2013年1月就诊时超出急诊 PCI 时间窗（≥12h），且胸痛缓解或无加重的 AMI 患者共97例，均持续泵入替罗非班48h，根据联合瑞舒伐他汀的剂量分为大剂量组（52例，20mg，1次/d口服，持续服药至梗塞后1月，改为常规剂量10mg，1次/d）和常规剂量组（45例，10mg，1次/d 口服）。全部患者经过保守治疗后于7～10d 行择期 PCI 治疗，比较两组间心肌灌注水平、术后1周和梗塞后30d 心脏功能，酶学改变[肌酸磷酸激酶（CK），乳酸脱氢酶（LDH）]及住院期间主要不良心血管事件（MACE）。结果：与常规剂量组比较，大剂量组梗死相关血管内血栓积分[（1.32±1.01）分比（0.81±0.78）分]、校正的 TIMI 帧数[（32.4±4.73）帧比（26.8±2.34）帧]显著减少（P ＝0.021，P ＜0.001）；择期 PCI 术后大剂量组心肌梗死溶栓试验（TIMI）血流明显优于常规剂量组（P ＝0.024）。大剂量组术后1周左室射血分数（LVEF）明显高于常规剂量组[（51.4±8.9）％比（47.7±8.7）％，P ＝0.021]；术后7d 及30d，两组 CK、LDH 水平均无明显差异（P ＞0.05）。术后住院期间和30d 两组患者均未出现 MACE。结论：替罗非班联合大剂量他汀治疗急性心肌梗死安全、有效，能降低冠脉内的血栓负荷，改善心肌组织灌注和心脏功能，而不增加主要不良心血管事件。

Objective：To observe and analyze the therapeutic effect and safety of tirofiban combined large dose statin in patients with acute myocardial infarction （AMI）,and evaluate its influence on myocardial perfusion and cardiac function.Methods：A total of 97 consecutive AMI patients visited to our hospital from May 2011 to January 2013, who were beyond the emergency PCI time window （≥12h）,their chest pain was remissive or not further aggravated were studied.All patients were pumped with tirofiban for 48h continuously;according to combined rosuvastatin dose,they were divided into large dose group （n = 52,20mg,once/d,until one month after infarction,then changed to routine dose of 10mg,once/d）and routine dose group （n=45,10mg,once/d）.All patients received se-lective PCI after 7 ~ 10d conservative treatment.Myocardial perfusion level,left ventricular ejection fraction （LVEF）on one week after PCI and 30d after AMI,enzymology changes [creatine （CK）,lactate dehydrogenase （LDH）]and major adverse cardiovascular events （MACE）during hospitalization were compared between two groups.Results：Compared with routine dose group,there were significant reductions in thrombus scores in infarct related artery （IRA）[（1.32±1.01）scores vs.（0.81±0.78）scores]and corrected TIMI frame [（32.4±4.73）vs. （26.8±2.34）]in large dose group （P =0.021,P 〈0.001）;after selective PCI,TIMI flow of large dose group was significantly better than that of routine dose group （P =0.024）.On one week after PCI,LVEF：（51.4±8.9）% of large dose group was significantly higher than that of routine dose group （47.7±8.7）%,P =0.021;there were no significant difference in levels of CK and LDH between two groups on 7d and 30d after PCI （P 〉0.05）.There was no MACE in both groups during hospitalization and 30d after PCI.Conclusion：Tirofiban combined large dose statin is safe and effective in patients with acute myocardial infarction,it can reduce intra-coronary thrombus burden,im-prove myocardial tissue perfusion and cardiac function without increasing MACE.