不同剂量瑞舒伐他汀治疗对ACS急诊PCI术后心脏保护作用的研究

Effeciency of different doses of rosuvastatin on ventricular remodeling in acute coronary syndrome patients after emergency percutaneous coronary intervention

目的：观察并探讨急性冠状动脉综合症（ACS）患者支架植入基础上,应用不同剂量瑞舒伐他汀治疗ACS支架植入术后心脏保护作用临床疗效。方法：收集2014-03-2015-01收治的137例ACS患者,其中男78例、女59例,年龄28~87岁,平均（61±4.7）岁。137例患者随机分为：①常规治疗组（对照组）：45例患者给予拜阿司匹林、氯吡格雷、硝酸酯类、β受体阻滞剂等常规药物治治疗;②瑞舒伐他汀常规剂量治疗组：45例患者在常规治疗组基础上＋每日睡前口服瑞舒伐他汀,剂量为10mg,1次/d;③瑞舒伐他汀大剂量治疗组：47例患者在常规治疗组基础上＋睡前口服瑞舒伐他汀,剂量为20mg,1次/d。疗程均为12周,于疗程1周、6周、12周后复查超声心动图与心电图,超敏C反应蛋白（hs-CRP）、脑钠肽前体（pro-BNP）水平,判定治疗效果,各组间心率与超声影像学判定指标如：左心室舒张期末内径（LVEDD）、左心室收缩期末内径（LVESD）、左心室舒张末期容积（LVEDV）、左心室收缩末期容积（LVESV）和左室射血分数（LVEF）。结果：治疗1周后,3组患者空腹静脉血检测hs-CRP、pro-BNP水平、超声心动指标比较,差异均无统计学意义;6周后,瑞舒伐他汀大剂量治疗组患者hsCRP、pro-BNP水平明显低于瑞舒伐他汀常规剂量治疗组（P〈0.05）及常规治疗组（P〈0.05）,而超声心动指标变化无明显差异;治疗12周后,瑞舒伐他汀大剂量治疗组患者hs-CRP、pro-BNP水平明显低于瑞舒伐他汀常规剂量治疗组（P〈0.05）及常规治疗组（P〈0.05）,超声心动指标变化差异明显（P〈0.05）。各组随访期间均未发生血栓栓塞与再狭窄。结论：急诊PCI术后3个月睡前加服大剂量瑞舒伐他汀可延缓粥样硬化的进程,有效抑制心脏恶性重塑,改善左心室收缩功能,降低不良事件发生率,明显改善远期预后,临床效果显著。

Objective：To observe and assess the clinical efficacy of different doses of rosuvastatin on ventricular remodeling in treating the acute coronary syndrome（ACS）patients with emergent percutaneous coronary intervention（PCI）and its prognosis.Method：From Mar.2014 to Jan.2015,137 admitted emergency cases of acute coronary syndrome（ACS）who accepted PCI in 24 hwere enrolled in the study and were randomized into routine treatment group or control group（45cases）,rosuvastatin standard dose group（45cases）and rosuvastatin high dose group（47cases）according to computer generated randomized number postoperatively.1The control group was given with conventional drugs such as aspirin,clopielogrel,nitrate andβ-blocker;2Conventional dose of rosuvastatin group：taking 10 mg/d rosuvastatin before sleep in addition to routine therapy;3large dose of rosuvastatin group：taking 20mg/d rosuvastatin before sleep in addition to the routine therapy.The levels of hs-CRP,MMP-9and pro-BNP in serum were detected and LVEDD,LVESD,LVEDV,LVESV,LVEF were recorded by ultrasound in 1,6and 12 weeks after treatment of PCI.Result：One week later,neither in biochemical indexes nor ultrasonic heartbeat graph indexes,no significant diference was found in the three groups;6weeks later,a significant diference was found in biochemical indexes（hs-CRP,MMP-9,pro-BNP）（P〈0.05）in the large dose rosuvastatin group,though there was no diference in the ultrasonic heartbeat graph indexes（LVEDD,LVESD,LVEDV,LVESV,LVEF）;12weeks later,compared with control group and conventional dose of rosuvastatin treatment group,the levels of serum hs-CRP,MMP-9,pro-BNP and LVEDD,LVESD,LVEDV,LVESV,LVEF in large dose rosuvastatin group were all significantly decreased,and ultrasonic indexes were improved obviously.The diferences were significant between the 6th week and the 12 th week（P〈0.05）.Conclusion：Our results suggested that after emergency PCI,a high does of rosuvastatin could delay the ventricular remodeling,increase heart function and improve the long-term prognosis.