不同负荷量他汀类药物对急性心肌梗死直接PCI术后心肌细胞的影响

Effects of different loading-dose statin on myocardial cells in patients with acute myocardial infarction after primary PCI

目的 比较不同负荷剂量的他汀类药物对急性心肌梗死直接PCI术后心肌细胞的影响.方法 纳入上海市奉贤区中心医院急性心肌梗死行急诊PCI术患者共140例,随机分为4组：负荷剂量组A（阿托伐他汀80 mg,35例）、负荷剂量组B（瑞舒伐他汀20 mg,35例）、常规剂量组C（阿托伐他汀20 mg,35例）和常规剂量组D（瑞舒伐他汀5 mg,35例）.检测PCI前后高敏C反应蛋白（hs-CRP）、血清淀粉样蛋白（SAA）、肌酸磷化□-同功□（CK-MB）、肌钙蛋白Ⅰ（cTnⅠ）、内皮素1（ET-1）、一氧化氮（N0）、纤溶酶原激活物（t-PA）、纤溶酶原激活物抑制物（PAI-1）,记录术后2h18导联心电图,计算ST段回落指数（STR）,比较PCI术后心肌梗死校正TIMI帧计数（CTFC）.术后30 d随访,测定左室射血分数（LVEF）并复查肝肾功能,记录主要心血管不良事件（MACE）.结果 PCI术后2 h hs-CRP、SAA、CK-MB、cTnⅠ、NO、t-PA各组均升高,但hs-CRP、SAA、CK-MB、cTnⅠ同组负荷剂量组低于常规剂量组[hs-CRP（21.76±5.38）mg/L比（25.02±5.76）mg/L、（22.22±5.33）mg/L比（28.56±6.42）mg/L;SAA（14.24±5.42）mg/L比（15.16±4.58）mg/L、（14.11±5.06）mg/L比（14.23 ±4.57）mg/L;CK-MB （594 ±238）U/L比（472±240）U/L、（556±273）U/L比（480±312）U/L;cTnⅠ （3.04±2.01）μg/L比（3.37±2.33）μg/L、（3.30±2.74）μg/L比（3.89±2.46）μg/L,P均＜0.05],NO、t-PA同组负荷剂量组高于常规剂量组[NO （40.31±10.86）μmol/L比（39.31±7.02） μmol/L、（39.49±7.69）μmol/L比（37.43±7.59）μmol/L;t-PA （0.47±0.19）ng/L比（0.46±0.17）ng/L、（0.45±0.16）ng/L比（0.41±0.14）ng/L,P均＜0.05];ET-1、PAI-1均降低,但负荷剂量组低于常规剂量组[ET-1 （67.34±11.71）ng/L比（84.43±8.07）ng/L、（64.29±15.79）ng/L比（79.97±10.76）ng/L;PAI-1 （0.25±0.12）ng/L比（0.36±0.16）ng/L、（0.31±0.14）ng/L比（0.52±0.19）ng/L,P均＜0.05].各项指标两负荷剂量组比较未见统计学差异（P＞0.05）;术后2hSTR、CTFC、术后30 d LVEF及主要心血管不良事件发生率,同组负荷剂量组均优于常规剂量组（P＜0.05）,两负荷剂量组比较未见统计学差异（P＞0.05）.结论 急性心肌梗死患者行直接PCI术前联合应用负荷量他汀类药物能够改善术后心肌微循环灌注,进一步减少心肌细胞的坏死,改善患者短期临床预后.阿托伐他汀与瑞舒伐他汀相比较临床疗效未见统计学差异.

Objective To compare the effects of different loading-dose statin on myocardial cells in patients with acute myocardial infarction（AMI） before primary PCI. Methods 140 patients with AMI given primary PCI in Department of Cardiology Fengxian Central Hospital were selected. randomly divided into four groups ：loading dosage group A （atorvastatin 80 mg, 35 cases）, loading dose group B （rosuvastatin 20 mg, 35 cases）, routine dose group C （atorvastatin 20 mg, 35 cases）, routine dose group D （rosuvastatin 5 mg, 35 cases）. The levels of high sensitive C-reactive protein（hs-CRP）,serum amyloid protein （SAA）, CK-MB, cTnI, endothelin（ET） ,nitric oxide（NO）, tissue type plasminogen activator （t-PA） , plasminogen activator inhibitor（PAI） were detected before and at after 2 hours of PCI. 18 lead electrocardiogram was recorded after 2 hours of PCI to calculate ST-segment resolution（STR）. Corrected TIMI frame count（CTFC） after PCI were compared. LVEF, hepatorenal function and the incidence of major adverse cardiovascular events （MACE） was followed up after PCI for 1 month . Results hs-CRP, SAA, CK-MB, cTnI, NO, t-PA were increased after two hours of PCI（P〈0.05）, but hs-CRP, SAA,CK-MB,cTnI in loading dose group were all lower than in routine dose group（P〈0.05）,NO、t-PA in loading dose group were all higher than in routine dose group（P〈0.05）; ET-1、PAI-1 were decreased after two hours of PCI（P〈0.05）, but in loading dose group were all lower than in routine dose group（P〈0.05）,all indicators were not statistically different among the loading dose groups（P〉0.05）. STR, CTFC, LVEF, Hepatorenal function and MACE were better in the loading dose groups after PCI（P〈0.05）,but were not statistically different among the loading dose groups（P〉0.05）.Conculsion loading-dose statin in patients with acute myocardial infarction before primary PCI can improved myocardial perfusion,further reduce the necrosis of myocardial cells ,improve the prognosis of patients in the time. There were no significant in clinical effects between atorvastatin and rosuvastatin. [Key words] Percutaneous coronary intervention; acute myocardial infarction;loading-dose statins