经皮冠状动脉介入术前单次负荷剂量与常规剂量瑞舒伐他汀对老年冠心病患者预后影响的比较

A comparison between efficacy of treatment with a single loading dose and a regular dose of rosuvastatin before percutaneous coronary intervention in elderly patients with coronary artery disease

目的：探讨老年冠心病患者行经皮冠状动脉介入术（PCI）治疗前单次负荷剂量瑞舒伐他汀对术后并发症的预防作用。方法将天津市第一中心医院心内科住院并接受PCI手术的216例老年冠心病患者按随机数字表法分为两组，每组108例。一组PCI术前24 h内给予负荷剂量瑞舒伐他汀20 mg（负荷剂量组），另一组PCI术前给予常规剂量瑞舒伐他汀5 mg（常规剂量组），两组患者均在术后口服瑞舒伐他汀5 mg/d；测定两组患者PCI前后血肌酐（SCr）、内生肌酐清除率（CCr）、心肌肌钙蛋白I（cTnI）、肌酸激酶同工酶（CK-MB）及超敏C-反应蛋白（hs-CRP）水平，计算对比剂肾病（CIN）、心肌梗死（心梗）发生率；术后随访1年，观察主要不良心血管事件（MACE）的发生率。结果 PCI术前两组患者SCr、CCr、cTnI、CK-MB、hs-CRP水平比较差异均无统计学意义（均P＞0.05）。两组PCI术后SCr、cTnI、CK-MB、hs-CRP均较术前升高，术后CCr较术前降低，且常规剂量组变化程度较负荷剂量组更显著〔SCr（μmol/L）为89.52±21.79比83.45±19.17，cTnI（μg/L）为0.49±0.23比0.35±0.18，CK-MB（μg/L）为5.98±1.16比3.05±0.71，hs-CRP（mg/L）为8.31±0.06比2.46±0.02， CCr （mL/min）为62.61±19.54比73.48±20.14，均P＜0.05〕；负荷剂量组CIN 〔7.41%（8/108）比17.59%（19/108）〕、心梗发生率〔1.85%（2/108）比8.33%（9/108）〕均明显低于常规剂量组（均P＜0.05）。术后30 d内负荷剂量组MACE发生率明显低于常规剂量组〔5.56%（6/108）比13.89%（15/108），P＜0.05〕，术后1年内MACE发生率负荷剂量组和常规剂量组比较差异无统计学意义〔19.44%（21/108）比27.78%（30/108），P＞0.05〕。结论老年冠心病患者PCI术前应用单次负荷剂量瑞舒伐他汀能保护心肾功能，降低CIN和心梗发生率以及术后近期MACE的发生率。

Objective To investigate the efficacy of treatment with a single loading dose of rosuvastatin before percutaneous coronary intervention （PCI） for prevention of complications after surgery in elderly patients underwent PCI with coronary artery disease.Methods 216 elderly patients with coronary artery disease admitted to Department of Cardiology of Tianjin First Center Hospital were divided into two groups at random （108 patients per group）. Within 24 hours before PCI, the patients of loading dose group received a loading dose of rosuvastatin 20 mg, while the patients of regular dose group received a regular dose of rosuvastatin 5 mg, and after surgery, both groups received rosuvastatin 5 mg/d orally. The serum creatinine （SCr）, endogenous creatinine clearance rate （CCr）, cardiac Troponin I （cTnI）, creatine kinase-MB isoenzyme （CK-MB） and hypersensitive C-reactive protein （hs-CRP） before and after PCI were detected, and the incidences of contrast induced nephropathy （CIN） and myocardial infarction were calculated in both groups. The patients were followed up for 1 year after PCI, and the incidence of major adverse cardiac events （MACE） was observed.Results There were no statistically significant differences in the levels of SCr, CCr, cTnI, CK-MB or hs-CRP before PCI between two groups （allP 〉 0.05）. While after PCI in two groups, the levels of SCr, cTnI, CK-MB and hs-CRP were higher than those before PCI, but CCr was lower than that before PCI, and the changes in regular dose group were more significant as compared with loading dose group [SCr （μmol/L）： 89.52±21.79 vs. 83.45±19.17, cTnI （μg/L）： 0.49±0.23 vs. 0.35±0.18, CK-MB （μg/L）： 5.98±1.16 vs. 3.05±0.71, hs-CRP （mg/L）： 8.31±0.06 vs. 2.46±0.02, CCr （mL/min）： 62.61±19.54 vs. 73.48±20.14, allP 0.05].Conclusion A single loading dose of rosuvastatin given before PCI in elderly patients with coronary cardiac disease can protect renal function and myocardium, reduce the incidences of CIN, myocardial infarction and the occurrence of MACE at early stage after PCI.