不同剂量瑞舒伐他汀对择期行PCI术的CHD患者心肌保护作用

The protective effects on myocardial injury of different-dose rosuvastatin at the perioperative period of PCI for CHD patients

目的探讨术前使用不同剂量瑞舒伐他汀对择期行经皮冠状动脉介入治疗(PCI)的冠状动脉粥样硬化性心脏病(CHD)患者的心肌保护作用。方法选择2012年10月至2014年2月收治的173例择期行PCI治疗的CHD患者根据术前使用瑞舒片他汀剂量不同分为A组(瑞舒伐他汀10 mg,58例)、B组(瑞舒伐他汀20 mg,59例)和C组(瑞舒伐他汀40 mg,56例),三组患者均在治疗前抽血测定肝肾功能、血脂指标,并观察其球囊扩张次数和置入支架情况。于术前、术后24 h、术后7 d测定各组患者血清超敏C反应蛋白(hs-CRP),白介素-18(IL-18),肌酸激酶同工酶(CK-MB),肌钙蛋白T(c Tn-T)水平。采用全自动生化分析仪测定肝肾功能、血脂及CK-MB、c Tn-T等指标,采用酶联免疫吸附试验法测定IL-8水平,免疫浊度法测定hs-CRP水平。结果三组患者治疗前肝肾功能、血脂指标及球囊扩张次数、置入支架数比较,差异均无统计学意义(P>0.05)。三组患者PCI术前hs-CRP、IL-18、CK-MB、c Tn-T水平比较,差异均无统计学意义(P>0.05);三组患者PCI术后24 h hs-CRP、IL-18、CK-MB、c Tn-I水平较同组术前均增高,而术后7 d hs-CRP、IL-18、CK-MB、c Tn-T水平较同组术前、术后24 h均降低,差异均有统计学意义(P<0.05);三组患者间术后7 d各指标水平比较,C组明显优于A、B组,差异均有统计学意义(P<0.05)。三组患者术后心血管事件和不良反应发生率[8.62%(5/58)、5.08%(3/59)、7.14%(4/56)]比较,差异均无统计学意义(P>0.05)。结论择期PCI术术前应用20、40 mg瑞舒伐他汀对PCI术后心肌损伤保护作用均优于10 mg,且40 mg作用效果优于20 mg,安全性良好。

Objective To approach the protective effects of different-dose rosuvastatin at the perioperative period on percutaneous coronary intervention （PCI） on patients with coronary heart disease （CHD）. Methods A total of 173 patients with PCI from Octoer 2012 to February 2014 were selected and divided into group A （10 mg rosuvastatin,n=58）,group B（20 mg rosu-vastatin,n=59）,and group C（40 mg rosuvastatin,n=56） according to the doses of rosuvastatin. The three groups were examined in liver and renal functions,serum lipid parameters as well as times of balloon dilatation and quantity of bailout-stenting. The level of high-sensitive c-reactive protein （hs-CRP）,interleukin-18 （IL-18）,creatine kinase isoenzyme （CK-MB）and troponin-T （cTn-T） were determined before the operation ,after postoperative 24 h and 7 d respectively. Automatic biochemical analyzer was used to detected to the parameters of liver and renal functions,blood fat,CK-MB and cTn-T as well as IL-8 by enzyme-linked immunosor-bent assay and hs-CRP by immunoturbidimetry. Results The liver and renal function,serum lipid parameters as well as times of balloon dilatation and quantity of bailout-stenting before the treatment among the three groups were compared ,whose difference has no statistic significance（P＞0.05）. The level of hs-CRP、IL-18、CK-MB、cTn-T before operation compared and showed no statistic significance in difference（P＞0.05）;The levels of hs-CRP、IL-18、CK-MB、cTn-I after postoperative 24 h were higher than those before operation;The levels of hs-CRP、IL-18、CK-MB、cTn-I after postoperative 7 d were higher than those before operation and after postoperative 24 h （P＜0.05）;Comparing these parameters after postoperative 7 d among the three groups ,group C is super visor than those of group B（P＜0.05）. The cardiovascular events and incidences of adverse effects after the operation among the three groups were compared[8.62%（5/58）,5.08%（3/59）,7.14%（4/56）],which was no difference in statistic significance （P＞0.05）. Conclusion The rosuvastatin with doses at 20 mg,40 mg against myocardial injury at the preoperative period with PCI after op-eration is better in than the dose at 10 mg,further,the effect of 40 mg-dose is supervisor than the dose at 20 mg.