大剂量阿托伐他汀序贯治疗对急性非ST段抬高型心肌梗死患者高敏C反应蛋白和短期主要不良心血管事件的影响

Effect of High Dose Atorvastatin Sequential Treatment on High Sensitivity C-reactive Protein and Short-time Major Adverse Cardiovascular Events in Acute Non-ST Segment Elevation Myocardial Infarction Patients

目的探讨大剂量阿托伐他汀序贯治疗对急性非ST段抬高型心肌梗死(NSTEMI)患者高敏C反应蛋白(hs-CRP)和短期主要不良心血管事件(MACE)的影响。方法将2010年9月至2012年4月在我院确诊为NSTEMI并择期PCI患者100例随机分为大剂量阿托伐他汀序贯治疗组(简称序贯治疗组)和阳性对照组。所有患者入院即刻给予80 mg阿托伐他汀钙,随后40 mg/d。序贯治疗组于术前6 h内追加40 mg阿托伐他汀钙,阳性对照组术前未追加阿托伐他汀钙。所有患者分别于PCI术前、术后24 h、48 h测定血脂、hs-CRP,并随访所有患者PCI术后12周内MACE。结果两组患者术后血脂水平与术前相比未见明显变化(P>0.05);与术前相比,两组患者术后hs-CRP水平均明显升高(P<0.05),序贯治疗组术后hs-CRP水平显著低于阳性对照组(P<0.05);两组患者12周内MACE发生率相比差异无统计学意义(4%比6%,P>0.05);两组均未见有临床意义的肝酶和肌酶升高,无不良反应发生。结论大剂量阿托伐他汀序贯治疗能一定程度抑制NSTEMI患者PCI术后内皮炎症反应,且安全性良好,但是不能减少12周内MACE。

Aim To observe the beneficial effects of high dose atorvastatin sequential treatment on high sensitivity C-reactive protein（ hs-CRP） and short-time major adverse cardiovascular events（ MACE） in acute non-ST segment elevation myocardial infarction（ NSTEMI） patients underwent elective percutaneous coronary intervention（ PCI）.Methods One hundred patients with NSTEMI from September 2009 to April 2012 underwent elective PCI were randomly divided into two groups： high dose atorvastatin sequential treatment group（ group A） and positive control group（ group B）.All patients were given 80 mg atorvastatin instantly and then 40 mg once a day. One the basis of hydration therapy,group A received additional 40 mg atorvastatin at 6 hours before PCI. Lipid levels and hs-CRP were measured and compared 24 hours and 48 hours post-PCI. 12-week incidence of MACE was done in a follow-up. Results Lipid levels had no significant change after PCI（ P〉0. 05）. In comparison with the levels before PCI,hs-CRP increased significantly in the two groups（ P〈0. 05）,and group A was significantly lower than group B（ P〈0. 05）. The incidence of MACE was sim-ilar in the two groups（ 4% vs. 6%,P〉0. 05）. The two groups showed no clinically significant liver enzymes and elevated muscle enzymes,and there were not adverse reactions in both groups. Conclusion High dose atorvastatin sequential therapy can be a certain degree of inhibition of endothelial inflammatory response in NSTEMI patients after PCI,and the security is good,but can＇t decrease the short-time MACE.