阿托伐他汀对急性ST段抬高型心肌梗死患者血浆内皮素及血小板功能的影响

The impact of different doses of atorvastatin on plasma endothelin and platelet function in acute ST-segment elevation myocardial infarction after emergency percutaneous coronary intervention

目的探讨不同剂量阿托伐他汀对急性sT段抬高型心肌梗死（STEMI）患者行急诊经皮冠状动脉介入治疗（PCI）术后血浆内皮素及血小板功能的影响。方法收集2012年2月至2014年2月确诊STEMI并行急诊PCI治疗120例STEMI患者，经计算机软件随机分成阿托伐他汀20mg治疗组（标准治疗组，60例）、阿托伐他汀40mg治疗组（强化治疗组，60例）。所有患者分别于他汀类药物治疗前及服药7d后取血，行血C反应蛋白（CRP）、血脂、血浆内皮素测定及通过血栓弹力图测定ADP诱导的血小板纤维蛋白凝块强度（MAADP）。结果治疗7d后，强化治疗组血浆内皮素水平明显低于标准治疗组[（0．49±0．21）pmol／L比（0．63±0．58）pmol／L，P〈0．05]；强化治疗组MAADP值亦明显低于标准治疗组[（38．4±17．4）mm比（45．7±14．5）mm，P〈0．05]。治疗7d后强化治疗组血内皮素水平与MAADP存在正相关关系（r=0．378，P〈0．05）。治疗7d后两组血CRP及LDL．C水平差异无统计学意义（P〉0．05）。结论急性STEMI患者早期给予40mg阿托伐他汀强化治疗可更显著地减轻血管内皮的损伤，从而改善内皮功能障碍；并同时降低患者的血小板活性。

Objective To investigate the effects of different doses of atorvastatin on plasma endothelin and platelet function in acute ST-segment elevation myocardial infarction （STEMI） patients after emergency percutaneous coronary intervention （PCI）. Methods A total of 120 patients with acute STEMI treated with emergency PCI were enrolled and randomly divided into 20 mg of atorvastatin treatment group （ standard group, n = 60）, and 40 mg of atorvastatin treatment group （ intensive group, n = 60）. The blood C reactive protein （CRP）, blood lipid profiles, plasma endothelin （ET） were measured before atorvastatin treatment and after 7 days of treatment, respectively. The platelet fibrin clot strength induced by ADP （MAADP） was determined by thrombelastography （TEG）. Results Seven days after of atorvastatin treatment, the level of plasma ET in intensive group was significantly lower than that in standard group [ （0. 49±0.21 ）pmol/L vs （0.63±0.58 ） pmol/L, P 〈 0.05 ]. Moreover, the MAADP in intensive group was significantly decreased compared with the standard group [ （38.4±17.4） mm vs （45.7±14.5 ） mm, P 〈 0.05 ]. There was a positive correlation between the ET level and MAADP in intensive group after treatment （r = 0. 378, P 〈 0.05 ）. However, no significantly differences could be viewed in the CRP and LDL-C levels between the two groups （ P 〉 0.05 ）. Conclusion In patients with acute STEMI, early administration of 40 mg atorvastatin after emergency PCI could significantly reduce the vascular endothelial injury, improve endothelial function, and reduce the residual platelet activity.