不同剂量阿托伐他汀对急性心肌梗死患者冠状动脉介入治疗后早期血脂及近期心血管事件影响的临床研究

Influence of different doses of atorvastatin on recent blood lipid and cardiovascular events after intervention therapy in patients with acute myocardial infarction

目的 探讨不同剂量阿托伐他汀对急性心肌梗死患者冠状动脉介入治疗后早期血清高敏C反应蛋白（hs-CRP）、血脂水平及近期心血管事件的影响.方法 选取2014年1-9月新疆维吾尔自治区人民医院收治的急性心肌梗死患者120例,所有患者均行急诊冠状动脉介入治疗,完全随机分为A组和B组,每组各60例.A组入院后在常规治疗的基础上给予阿托伐他汀20 mg/d,B组在常规治疗的基础上给予阿托伐他汀40 mg/d,持续治疗1个月;比较不同剂量阿托伐他汀对术后早期（1周内）hs-CRP、血脂水平的影响,同时记录患者近期（1个月内）心血管不良事件（心绞痛发生次数）.结果 治疗1周后,2组血清hs-CRP、高密度脂蛋白胆固醇（HDL-C）、总胆固醇、低密度脂蛋白胆固醇（LDL-C）水平较治疗前均明显下降,差异均有统计学意义[A组：（6.1±1.6）mg/L比（15.6±3.6）mg/L、（0.86±0.20） mmol/L比（1.00±0.24） mnmol/L、（3.7±0.6） mmol/L比（4.5±1.0）mmol/L、（2.3±0.6） mmol/L比（3.0±0.9） mmol/L;B组：（6.0±1.8） mg/L比（15.6±5.3）mg/L、（0.81±0.15） mmol/L比（0.97±0.25） mmol/L、（2.9 ±0.5） mmol/L比（4.1±0.9）mmol/L、（1.7±0.4）mmol/L比（2.7±0.8）mmol/L,均P＜0.05];B组在治疗后LDL-C下降大于A组（P＜0.01）.2组均未出现心源性死亡,A组心绞痛发生率明显高于B组,差异有统计学意义[43.3％ （26/60）比16.7％（10/60）,x2 =5.079,P＜0.05）.结论 急性心肌梗死介入术后患者应用阿托伐他汀治疗对降低hs-CRP、血脂水平有效,并且40mg较20mg阿托伐他汀早期降脂及减少近期心绞痛事件作用更佳.

Objective To explore the influence of different doses of atorvastatin on recent hs-CRP,blood lipid and cardiovascular events after intervention therapy in patients with acute myocardial infarction （AMI）.Methods Totally 120 patients with AMI undergoing emergency percutaneous coronary intervention from January to September 2014 were randomly divided into 20 mg group （60 cases） given 20 mg atorvastatin in addition to conventional treatment,and 40 mg group （60 cases） given 40 mg atorvastatin in addition to conventional treatment.After 1 week of treatment,the levels of hs-CRP and blood lipid were measured;after 1 month of treatment,the adverse cardiovascular events （frequency of angina） were recorded and compared between the two groups.Results One week after treatment,the levels of hs-CRP,high density lipoprotein cholesterol （HDL-C）,total cholesterol and low density lipoprotein cholesterol （LDL-C） were all significantly decreased in both 20 mg group [（6.1 ± 1.6） mg/L vs （15.6±3.6） mg/L,（0.86 ±0.20） mmol/L vs （1.00±0.24） mmol/L,（3.7 ±0.6） mmol/L vs （4.5 ± 1.0） mmol/L,（2.3 ± 0.6） mmol/L vs （3.0 ± 0.9） mmol/L] and 40 mg group [（6.0 ± 1.8） mg/L vs （15.6 ± 5.3） rng/L,（0.81 ±0.15） mmoL/L vs （0.97 ±0.25） mmol/L,（2.9 ±0.5） mmol/L vs （4.1 ±0.9） mmol/L,（1.7 ± 0.4） mmol/L vs （2.7 ± 0.8） mmol/L] （P 〈 0.05）;the level of LDL-C after treatment in 40 group was significantly lower than that in 20 group （P 〈0.01）.There was no cardiac death,and the frequency of angina in 20 mg group was significantly higher than that in 40 mg group [43.3% （26/60） vs 16.7% （10/60）,x2 =5.079,P =0.024].Conclusion In patients with AMI,atorvastatin can effectively reduce the levels of hs-CRP and blood lipid level during an early period after percutaneous coronary intervention;in addition,40 mg atorvastatin is better than 20 mg atorvastatin regarding decreasing blood lipid levels and frequency of angina.