他汀类药物治疗对2型糖尿病并ST段抬高急性心肌梗死患者磷脂酶A2和心功能的影响

Effect of perioperative Atorvastatin treatment on lipoprotein-associated phospholipase A2 level and heart function in elderly patients with acute ST-segment elevation myocardial infarction and type 2 diabetes

目的探讨围术期强化阿托伐他汀治疗对合并老年2型糖尿病ST段抬高急性心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）术后脂蛋白相关磷脂酶A2（LpPLA2）和心功能的影响。方法选择2012年9月至2014年8月因STEMI行急诊PCI且合并2型糖尿病的老年患者83例，其中男52例，女31例，年龄60～78岁。按随机数字表法分为两组，标准组42例：术前顿服阿托伐他汀20mg，术后继续予阿托伐他汀20mg／晚；强化组41例：术前顿服阿托伐他汀40mg，术后继续予阿托伐他汀40mg／晚。所有患者分别于治疗前和PCI术后3d、7d检测Lp—PLA2、脑利钠肽（BNP）水平；并于PCI术后1d、1个月行心脏超声检测患者左心室舒张末期内径（LVEDD），计算左心室射血分数（LVEF）。结果术后3d与术前比较，标准组和强化组患者LpPLA2[（297．8±53．4）mg／L比（194．7±39．1）mg／L与（270．3±47．0）mg／L比（205．6±27．5）mg／L3、BNP水平均升高，且标准组高于强化组（均P％0．05）；术后7d与术后3d比较，LpPI．A2[（249．3±42．3）mg／L比（297．8±53．4）mg／L与（227．2±33．3）mg／L比（270．3±47．0）mg／L]、BNP水平降低，但较治疗前仍升高，且标准组高于强化组（均P〈0．05）；术后1d，2组患者LVEDD、LVEF比较，差异无统计学意义（均P〉0．05）；与术后1d比较，术后1个月两组患者LVEDD降低，LVEF升高（均P〈0．05）。结论围术期强化阿托伐他汀治疗能增强合并2型糖尿病的老年STEMI患者急诊PCI术后急性期斑块稳定性，改善心脏功能。

Objective To investigate the effects of perioperative high loading dose of Atorvastatin treatment on lipoprotein-associated phospho[ipase A2 （Lp PLA2） and heart function in patients with acute ST segment elevation myocardial infarction and type 2 diabetes who underwent emergency percutaneous coronary intervention （PCI）. Methods Totally 83 cases with acute ST- segment elevation myocardial infarction and type 2 diabetes who underwent emergency PCI from September 2012 and August 2014 were randomly divided into two groups. In control group （n=42） patients took Atorvastatin 20 mg daily before and after emergency PCI, and in intensive group （n= 41） patients took atorvastatin 40 mg daily before and after emergency PCI. Each group was given the same basic treatment according to the guideline. Blood samples were obtained from all the patients before PCI and at 3, 7 days after PCI, and levels of Lp-PLA2 and brain natriuretic peptide （BNP） were detected. And the left ventricular end diastolic diameter （LVEDD） and left ventricular ejection fraction （LVEF） were measured at 1 day and 1 month after PCI. Results The levels of Lp PLA2 and BNP at 3 days after PCI were obviously increased in the two groups versus baseline 〈（297.8± 53.4） mg/L vs（194. 7±39. 1） mg/L, （270. 3±47. 0） mg/L vs. （205.6±27. 5） mg/L, both P〈 0.05], and decreased in intensive versus control group [（270.3±47.0） mg/L vs （297, 8±53.4 ） mg/L and （353.8±76.3） mg/L va （375.4±57.0） mg/L, P〈0.05]. And levels of Lp PLA2 and BNP at 7 days after PCI were improved more in intensive than in control group （（227.2±33.3）mg/L w （249.3±42.3） mg/L, （206.0±48.2）mg/L vs （267.6±50.8） rag/L, P〈0.05]. There were no significant differences in LVEDD and LVEF between the two groups 1 day after PCI. Meanwhile, the LVEDD was decreased and the LVEF was increased in the two groups 1 month after PCI as compared with 1 day after PCI （both P〈0.05）. Conclusions Perioperative high loading dose of Atorvastatin treatment may stabilize the plaques and improve heart function in acute stage in patients with acute ST segment elevated myocardial infarction and type 2 diabetes after emergency PCI.