急诊经皮冠状动脉介入治疗术前负荷瑞舒伐他汀和应用替罗非班对心肌再灌注损伤及预后的影响

Effect of high-loading-dosage of rosuvastatin and tirofiban before percutaneous coronary intervention on myocardial reperfusion injury

目的 探讨急诊经皮冠状动脉介入治疗（PCI）术前负荷瑞舒伐他汀和应用替罗非班对PCI相关心肌再灌注损伤及预后的影响.方法 选择2012年4月至2014年1月于山东省泰安市中心医院接受急诊PCI治疗的急性心肌梗死患者85例,采用随机数字表法分为观察组（43例）和对照组（42例）.观察组术前负荷瑞舒伐他汀20 mg,并冠状动脉推注替罗非班10 μg/kg,继之以0.15 μg/（kg＆#183;min）静脉泵入36 h,术后继续服用瑞舒伐他汀10 mg/d,对照组仅于术后服用瑞舒伐他汀10 mg/d.PCI术后分析患者冠状动脉造影结果,进行心肌梗死溶栓治疗（TIMI）血流分级;同时应用酶联免疫吸附法检测2组PCI术前及术后24 h可溶性细胞间黏附分子（sICAM-1）、可溶性血管细胞黏附分子（sVCAM-1）和高敏C反应蛋白（hs-CRP）水平;并记录术后6个月再发心绞痛、心肌梗死、死亡等主要不良心血管事件（MACE）的发生情况.结果 观察组的TIMI 3级血流分级比例明显高于对照组,差异有统计学意义[79.1％（34/43）比50.0％ （21/42）,P＜0.0l];术后24h,观察组sICAM-1、sVCAM-1、hs-CRP明显低于对照组[（24.2 ±2.3）μg/L比（37.2±3.3） μg/L、（26.2±2.9）μg/L比（43.3±3.8） μg/L、（8.2±5.0）mg/L比（10.9 ±4.7）mg/L],差异有统计学意义（P＜0.05）.观察组和对照组再发心绞痛、心肌梗死发生率差异无统计学意义（P＞0.05）.2组无死亡事件发生.结论 急性心肌梗死患者急诊PCI术前负荷瑞舒伐他汀和应用替罗非班可改善TIMI分级,降低PCI相关心肌再灌注损伤,并改善患者预后.

Objective To explore the effect of high-loading-dosage of rosuvastatin and tirofiban on myocardial reperfusion injury and prognosis in patients with acute myocardial infarction （AMI） undergoing emergency percutaneous coronary intervention （PCI）.Methods Totally 85 patients with AMI undergoing emergency PCI from April 2012 to January 2014 were enrolled and randomly divided into observation group （43 cases） given high-loading-dosage of rosuvastatin （20 mg,oral） and tirofiban [10 μg/kg bolus,then 0.15 μg/（kg ＆#183; min） infusion for 36 h] before operation,rosuvastatin （10 mg/d） after operation,and control group （42 cases） given rosuvastatin 10 mg/d after operation.The thrombolysis in myocardial infarction （TIMI） flow grade was assessed by coronary angiography at the end of PCI;the plasma concentrations of soluble intercellar adhesion molecules 1 （sICAM-1）,soluble vascular cell adhesion molecule l （sVCAM-1） and high sensitivity C reactive protein （hs-CRP） were measured by enzyme-linked immunosorbent assay （ELISA） before and after PCI;the postoperative major adverse cardiac events 6 months after PCI,including recurrence of angina pectoris,myocardial infarction and death,were recorded and compared between the two groups.Results The proportion of TIMI grade 3 in observation group was significantly higher than that in control group [79.1% （34/43） vs 50.0% （21/42）] （P 〈 0.01）;24 h after PCI,the levels of sICAM-1,sVCAM-1 and hs-CRP were significantly lower than those in control group [（24.2 ± 2.3） μg/L vs （37.2±.3） μg/L,（26.2±.9） μg/L vs （43.3±.8） μg/L,（8.2±.0） mg/L vs （10.9±.7） mg/L] （P 〈 0.05）.Six months after PCI,the incidences of angina pectoris recurrence and myocardial infarction in observation group were not significantly different from those in control group （P 〉 0.05）;no death occurred in both groups.Conclusion Application of high-loading-dose of rosuvastatin and tirofiban before operation can decrease the myocardial tissue perfusion injury and improve the prognosis in AMI patients undergoing emergency PCI.