大剂量瑞舒伐他汀对急性心肌梗死后心肌纤维化、心室重构及心功能的影响

Effect of high-dose rosuvastatin on myocardial fibrosis, ventricular remodeling and cardiac function in patients with acute myocardial infarction

目的观察大剂量瑞舒伐他汀治疗急性心肌梗死(AMI)对患者心肌纤维化、心室重构及心功能的影响。方法选取我院心血管内科2015年1月至2016年3月收治的82例AMI患者作为研究对象,采用数表法随机法分为低剂量组和高剂量组,每组41例。入院后所有患者均常规给予阿司匹林、氯吡格雷、血管紧张素抑制剂、β受体阻滞剂、依诺肝素等,同时行经皮冠状动脉介入术(PCI)。低剂量组患者给予10 mg瑞舒伐他汀治疗,高剂量组给予20 mg瑞舒伐他汀治疗,比较两组患者治疗前和治疗24周时心肌纤维化、心室重构及心功能相关指标。结果高剂量组患者治疗24周时N末端脑钠肽前体(NT-pro BNP)和基质金属蛋白酶-9(MMP-9)由治疗前的(722.6±163.4)pg/mL、(235.3±65.7)μg/L下降至(179.5±41.7)pg/mL、(156.4±35.8)μg/L,与治疗前和对照组比较差异均有统计学意义(P<0.05);高剂量组患者治疗24周时的半乳凝素-3(Gal-3)为(5.1±1.6)ng/mL,较治疗前的(4.5±1.5)ng/mL略有上升,但差异无统计学意义(P>0.05),而对照组患者治疗24周时的Gal-3与治疗前和高剂量组比较差异均有统计学意义(P<0.05);高剂量组患者治疗24周时的左室收缩期末内径(LVESD)、左室舒张期末内径(LVEDD)、左室收缩末期容积(LVESV)、左室舒张末期容积(LVEDV)和左室射血分数(LVEF)分别为(34.6±7.2)mm、(47.9±10.2)mm、(47.7±8.2)mL、(93.2±12.9)mL、(56.8±9.3)%,与对照组比较差异均具有统计学意义(P<0.05)。结论大剂量瑞舒伐他汀治疗AMI对患者的心肌纤维化、心室重构及心功能改善更加明显,且不增加不良反应。

Objective To observe the effect of high-dose rosuvastatin on myocardial fibrosis,ventricular remodeling and cardiac function in patients with acute myocardial infarction（AMI）.Methods A total of 82 patients with AMI in Department of Cardiovascular Medicine in our hospital from January 2015 to March 2016 were selected as the research objects.All patients were randomly divided into low dose group and high dose group according to the random number table,with 41 patients in each group.After admission,all patients were treated with aspirin,clopidogrel,angiotensin inhibitors,beta-blockers,and enoxaparin,as well as percutaneous coronary intervention（PCI）.Low dose group patients was treated with 10 mg rosuvastatin,and the high dose group was treated with 20 mg rosuvastatin.Myocardial fibrosis,ventricular remodeling and cardiac function were compared between the two groups before treatment and after 24 weeks of treatment.Results The N terminal brain natriuretic peptide（NT-pro BNP） and matrix metalloproteinases 9（MMP-9） of High dose group patients treated for 24 weeks were significantly lower than those before treatment（179.5±41.7） pg/mL vs（722.6±163.4） pg/mL,（156.4±35.8） μg/L vs（235.3±65.7） μg/L,and the differences were statistically significant（P0.05）.The galectin-3（Gal-3） in high dose group patients treated for 24 weeks was（5.1±1.6） ng/mL,which was slightly higher than that before treatment of（4.5±1.5） ng/mL,but the difference was not statistically significant（P0.05）.The Gal-3 in control group patients treated for 24 weeks,compared with before treatment and high dose group,showed statistically significant differences（P0.05）.Left ventricular end systolic diameter（LVESD）,left ventricular end diastolic diameter（LVEDD）,left ventricular end systolic volume（LVESV）,left ventricular end diastolic volume（LVEDV） and left ventricular ejection fraction（LVEF） of high dose group patients treated for 24 weeks were respectively（34.6±7.2） mm,（47.9±10.2） mm,（47.7±8.2） mL,（93.2±12.9） mL（56.8±9.3）%,showing statistically significant difference with those in the control group（P0.05）.Conclusion High-dose rosuvastatin can improve myocardial fibrosis,ventricular remodeling and cardiac function in patients with AMI,without increasing the adverse reactions.