大剂量阿托伐他汀对急性心肌梗死PCI术患者MMP-9及左心房功能的影响

The effect of high dose atorvastatin on MMP-9 and left atrial function in patients with acute coronary acute myocardial infarction after PCI

目的探讨急性心肌梗死经皮冠状动脉介入治疗(PCI)术后患者给予大剂量阿托伐他汀治疗对血清基质金属蛋白酶9(MMP-9)、高敏C反应蛋白(hs-CRP)水平及左心房功能的影响。方法将64例确诊为急性心肌梗死、PCI术后存活患者随机分为常规剂量阿托伐他汀治疗组和大剂量阿托伐他汀治疗组,每组32例。大剂量组术前给予阿托伐他汀80 mg负荷量口服,术后再予40 mg/晚维持4周,后改为20 mg/晚;常规剂量组予20 mg/晚治疗。分别于术前、术后1周、术后12周采用ELISA法测定MMP-9、hs-CRP水平,超声检测左心房功能。结果大剂量阿托伐他汀组较常规剂量组能更进一步降低血脂,在PCI手术前两组MMP-9、hs-CRP水平均明显高于正常水平,治疗后均迅速下降,1周时大剂量组MMP-9、hs-CRP水平显著低于常规剂量组,12周后两组间差异无统计学意义(P>0.05)。大剂量组1周时左心房主动收缩排空分数(LAAEF)较常规治疗组高(P<0.05);术后12周时大剂量组左心室舒张末期容积(LVEDV)、左心房主动收缩排空容积(LAAE)、LAAEF与常规治疗组比较差异均有统计学意义(P<0.05)。结论急性心肌梗死PCI术后患者给予大剂量阿托伐他汀治疗可进一步降低MMP-9、hs-CRP水平,改善左心房功能。

Objective To investigate the effect of high dose atorvastatin on matrix metallo proteinase-9 （MMP-9）, high sensitive C-reactive protein （hs-CRP） and left atrial function in patients with acute myocardial infarction after percutaneous coronary intervention（PCI）. Methods 64 patients with acute myocardial infarction after PCI were randomly divided into conventional dose atorvastatin group and high-dose atorvastatin group （32 patients per group）. For the high-dose atorvastatin group, 80 mg atorvastatin loading dosewas given orally, followed by 40 mg/night for 4 weeks, after that 20 mg/night for maintain. Conventional dose group was given atorvastatin 20 mg/night. MMP-9 and hs-CRP levels were measured by ELISA at preoperative, 1 week later and 12 weeks later. Left atrial function was measured by ultrasound. Results High-dose atorvastatin group could further reduce blood lipid than the conventional group. The MMP-9 and hs-CRP levels were significantly higher than those of conventional dose; after 12 week, the differences were not significant. In high-dose group, left atrium active ejection fraction was significantly higher than that of the conventional group after 1 week （P〈0.05）. Left atrium left ventricular end diastolic volume and left atrial active ejection fraction were significantly higher than those of the conventional group after 12 weeks （P〈0.05） ; left atrium active emptying volume was significantly different between 2 groups （P〈0.01）. Conclusion High-dose atorvastatin could further reduce MMP-9 and hs-CRP levels in patients with acute myocardial infarction after PCI and improve left atrial function.