术前负荷剂量瑞舒伐他汀对老年冠心病PCI术后心肌损伤的保护作用

Protective effect by preoperative load dose of rosuvastatin for myocardial damage after PCI in senile coronary heart disease

目的探讨术前负荷剂量瑞舒伐他汀治疗对老年冠心病行经皮冠状动脉介入治疗（PCI）术后心肌损伤的影响及其保护机制。方法 82例行PCI治疗的老年冠心病患者,随机分为对照组（40例）和负荷瑞舒伐他汀组（42例）。对照组术前不给予瑞舒伐他汀负荷,负荷瑞舒伐他汀组术前2-4 h内给予瑞舒伐他汀20 mg负荷,两组术后均给予瑞舒伐他汀10 mg/d长期服用。比较两组术前、术后24 h、术后7 d心肌标志物超敏肌钙蛋白T（hs-c Tn T）以及超敏C反应蛋白（hs-CRP）、高迁移率族蛋白B1（HMGB1）、单核细胞趋化蛋白-1（MCP-1）等炎性因子的变化。结果 PCI术后24 h负荷瑞舒伐他汀组hs-c Tn T的升高比例低于对照组（P〈0.05）,PCI术后7 d两组hs-c Tn T的升高比例差异无统计学意义（P〉0.05）。PCI术后24 h负荷瑞舒伐他汀组hs-CRP、HMGB1和MCP-1的升高幅度低于对照组,差异具有统计学意义（P〈0.05）。结论 PCI术前负荷剂量瑞舒伐他汀可以降低术后心肌损伤发生率及炎症反应,值得临床推广应用。

Objective To investigate influence and protection mechanism of preoperative load dose of rosuvastatin for myocardial damage after percutaneous coronary intervention （PCI） in senile coronary heart disease.Methods A total of 82 senile coronary heart disease patients receiving PCI were randomly divided into control group （40 cases） and rosuvastatin load dose group （42 cases）. The control group was given no preoperative rosuvastatin, while the rosuvastatin load dose group received 20 mg rosuvastatin in 2-4 h before operation. Both groups received 10 mg/d of rosuvastatin after operation for long-term administration. Changes of cardiac markers, high-sensitivity cardiac troponin T （hs-cTnT）, high-sensitivity C-reactive protein （hs-CRP）, high mobility group box 1 （HMGB1）, and monocyte chemoattractant protein-1 （MCP-1） as inflammatory factors were compared between the two groups before and in 24 h, 7 d after operation.Results In 24 h after PCI, the rosuvastatin load dose group had lower proportion of increased hs-cTnT than the control group （P〈0.05）. In 7 d after PCI, the difference of increased hs-cTnT had no statistical significance between the two groups （P〉0.05）. In 24 h after PCI, the rosuvastatin load dose group had lower increasing in hs-CRP, HMGB-1 and MCP-1 than the control group, and their difference had statistical significance （P〈0.05）.Conclusion Implement of preoperative load dose of rosuvastatin can reduce incidence of postoperative myocardial damage and inflammatory reactions. It is worth clinical promotion and application.