急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗术前高剂量瑞舒伐他汀对炎性因子和心肌灌注的影响

Effects of high dose rosuvastatin before primary percutaneous coronary intervention on inflammatory factors and myocardial perfusion in patients with acute ST-segment elevation myocardial infarction

目的:探讨急性ST段抬高型心肌梗死(STEMI)患者急诊经皮冠状动脉介入治疗(PCI)术前高剂量瑞舒伐他汀对血清炎性因子和心肌灌注的影响。方法:选择2013-01-2014-12在我院就诊的急性STEMI患者145例为研究对象,根据急诊PCI术前是否服用高剂量瑞舒伐他汀将患者分为常规治疗组(A组)70例和高剂量瑞舒伐他汀组(B组)75例。在急诊PCI术后2组患者均给予冠心病二级预防治疗,其中瑞舒伐他汀钙均给予10mg,每晚1次。所有患者在入院后24h内及发病第7天抽取外周静脉血测定血清炎性因子hs-CRP、TNF-α、IL-6浓度,并采用TIMI血流分级和校正的TIMI帧数计数(CTFC)评价心肌灌注情况。结果:2组患者治疗1周后血清炎性因子hs-CRP、TNF-α和IL-6浓度较发病24h内均明显降低(P<0.05)。治疗1周后B组患者hsCRP、TNF-α和IL-6的浓度较A组患者亦明显降低[(2.51±1.09)mg/L vs.(4.47±2.62)mg/L,(14.78±2.86)ng/L vs.(18.76±3.98)ng/L,(21.75±9.78)ng/L vs.(34.37±10.98)ng/L,P<0.05]。B组患者急诊PCI术后CTFC明显低于A组[(27.4±11.6)帧vs.(35.8±12.7)帧,P<0.05]。结论:急性STEMI患者急诊PCI术前高剂量瑞舒伐他汀治疗可减少患者的炎症反应,增加心肌灌注。

Objective：To investigate effects of high-dose rosuvastatin before primary percutaneous coronary intervention on inflammatory factors and myocardial perfusion in patients with acute ST-segment elevation myocardial infarction.Method：One hundred and forty-five patients with acute ST segment elevation myocardial infarction who were hospitalized in Daxing Hospital of the Capital Medical University from January 2013 to December 2014 were registered.They were divided into two groups：high dose rosuvastatain group（75cases）and conventional therapy group（75cases）,depending on whether taking high-dose rosuvastatain before the emergency PCI.All the patients were given secondary prevention treatment of coronary heart disease after emergency PCI,including rosuvastatain 10 mg per night.The blood samples were collected from peripheral vein within 24 hours after admission and on the seventh day after onset.The serum concentrations of inflammatory factors such as high sensitivity C reactive protein（hs-CRP）,tumor necrosis factor-α（TNF-α）and Interleukin 6（IL-6）were assayed.The myocardial perfusion was evaluated by TIMI flow grade and corrected TIMI frame count.Result：The serum concentrations of factors hs-CRP,TNF-α,IL-6after 1week＇s therapy in both conventional therapy group and high-dose rosuvastatin group were lower than those within 24 hours after onset,P〈0.05.The concentration of hs-CRP,TNF-α,IL-6in high-dose rosuvastatin group was obviously decreased than that in conventional therapy group [（2.51±1.09）mg/L vs.（4.47±2.62）mg/L,（14.78±2.86）ng/L vs.（18.76±3.98）ng/L,（21.75±9.78）ng/L vs.（34.37±10.98）ng/L,P〈0.05].The corrected TIMI frame counts after primary PCI in high-dose rosuvastatin group were lower than those in conventional therapy group[（27.4±11.6）counts vs.（35.8±12.7）counts,P〈0.05].Conclusion：The high-dose rasuvastatin before primary percutaneous coronary intervention can reduce inflammatory reaction and raise myocardial perfusion in patients with acute ST-segment elevation myocardial infarction.