经皮冠状动脉介入术前他汀再负荷对围术期循环内皮祖细胞及炎症因子的影响

Effects of statin reloading before percutaneous coronary intervention on circulatory endothelial progenitor cells and inflammatory cytokines

目的:探讨经皮冠状动脉介入术(PCI)术前大剂量阿托伐他汀再负荷治疗对长期他汀治疗的稳定性冠心病病人围术期循环内皮祖细胞(EPCs)及炎症因子的影响。方法:将长期他汀治疗并择期PCI的稳定性心绞痛患者随机分为3组:术前12 h 80 mg阿托伐他汀负荷及术前2 h追加40 mg阿托伐他汀再负荷治疗(80 mg再负荷组)、连续7 d 40 mg阿托伐他汀再负荷治疗(40 mg再负荷组)和无阿托伐他汀再负荷治疗(无再负荷组)。应用流式细胞术分别测定所有患者PCI术前1 h、术后1 h、6 h及24 h外周血中标记为CD45-/CD133+/CD34+、CD45-/CD34+/KDR+和CD45-/CD144+/KDR+的EPCs数量;术前即刻及术后24 h分别测定血清可溶性细胞间黏附分子1(sICAM-1)、C反应蛋白(CRP)和肌钙蛋白(TnI)水平。结果:(1)80 mg再负荷组患者PCI术前与术后1 h外周血标记为CD45-/CD133+/CD34+和CD45-/CD34+/KDR+的EPCs数量均有显著差异(P<0.05),PCI术前与术后6 h外周血标记为上述两种指标的EPCs差异显著(P<0.05);外周血标记为CD45-/CD144+/KDR+的EPCs在PCI术前和术后无显著变化;无再负荷组及40 mg再负荷组患者外周血EPCs在PCI术前和术后无显著变化。(2)PCI术后24 h无再负荷组sICAM-1及CRP水平较术前显著升高(P<0.05)。PCI术后24 h 80 mg再负荷组和40 mg再负荷组sICAM-1和CRP的升高幅度有减少趋势。(3)与无再负荷组相比,80 mg再负荷组PCI术后24 h血清TnI升高幅度显著降低(P<0.05)。结论:PCI术前阿托伐他汀再负荷方式影响围术期外周血EPCs数量。术前大剂量他汀短时间再负荷治疗提高围术期外周血中早期EPCs的数量。PCI术前阿托伐他汀再负荷治疗减少围术期炎症反应及心肌损伤。

AIM： To investigate the effects of atorvastatin reloading in pre-percutaneous coronary intervention（ PCI） period on endothelial progenitor cell（ EPC） count and inflammatory cytokine expression in the stable angina pectoris patients who had previously received long-term statin treatment. METHODS： The patients with stable angina pectoris that had received long-term statin therapy and planned to accept PCI were randomized into 3 groups： 80 mg atorvastatin 12 h and 40 mg 2 h before coronary angioplasty（ 80 mg reloading）,pre-operatively with 40 mg /d atorvastatin for 7 d（ 40 mg reloading）,and without atorvastatin reloading（ no reloading）. CD45^-/CD133^＋/CD34^＋,CD45^-/CD34^＋/KDR^＋and CD45^-/CD144^＋/KDR＋EPCs in 100 μL peripheral blood were determined by flow cytometry 1 h prior to PCI and 1 h,6h and 24 h after PCI. The serum concentrations of soluble intercellular adhesion molecule 1（ sICAM-1）,C-reactive protein（ CRP） and troponin I（ TnI） were analyzed immediately prior to and 24 h after PCI. RESULTS：（ 1） In 80 mg reloading group,the numbers of circulating CD45-/CD133＋/CD34^＋and CD45^-/CD34^＋/ KDR^＋early differentiation stage EPCs 1h and 6 h after coronary angioplasty was significantly elevated compared with those before PCI（ P 〈0.05）.（ 2） In control group,the serum concentrations of sICAM-1 and CRP 24 h after PCI were significantly elevated（ P 〈0.05） compared with preoperative values.（ 3） The rise in serum TnI concentration from pre-to post-operation in 80 mg reloading group was lower than that in control group. CONCLUSION： The method of atorvastatin reload before PCI affects the number of EPCs in peri-operative period. High dose of atorvastatin application before PCI triggers early EPC circulation. The serum levels of post-operative inflammatory cytokine sICAM-1 as well as CRP are reduced by atorvastatin reloading before PCI.