不同剂量阿托伐他汀对经皮冠状动脉介入治疗后患者心脏不良事件发生率的影响

Effect of different doses of atorvastatin on the incidence of adverse cardiac events in patients after percutaneous coronary intervention

目的研究不同剂量阿托伐他汀对经皮冠状动脉介入治疗后患者心脏不良事件发生率的影响。方法 210例择期行经皮冠状动脉介入治疗的患者,按照随机数字表法分为低剂量组、中剂量组和高剂量组,每组70例。低剂量组、中剂量组和高剂量组患者分别于介入治疗前12 h予以20、40、60 mg阿托伐他汀口服。对三组患者术前及术后24 h的肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(CTNI)、超敏-C反应蛋白(hs-CRP)及血内皮素(ET)水平进行检测;术后对患者随访1个月,对其心肌梗死、心源性休克死亡和再次靶血管血管重建等心脏不良事件进行统计。结果三组患者术后24 h的CK-MB、CTNI水平均显著高于术前,而hs-CRP及ET水平均显著低于术前,差异具有统计学意义(P<0.05)。高剂量组及中剂量组术后24 h的CK-MB、CTNI水平均显著低于低剂量组(P<0.05),高剂量组术后24 h的CK-MB、CTNI水平亦显著低于中剂量组(P<0.05)。高剂量组术后24 h的hs-CRP及ET水平均显著低于中剂量组和低剂量组(P<0.05),中剂量组和低剂量组术后24 h的hs-CRP及ET水平比较差异无统计学意义(P>0.05)。术后随访1个月,高剂量组患者的心脏不良事件发生率2.9%显著低于低剂量组和中剂量组的20.0%、14.3%,差异具有统计学意义(P<0.05)。结论经皮冠状动脉介入治疗前予以60 mg阿托伐他汀能显著改善患者的心肌损伤及炎症反应情况,降低心脏不良事件的发生率。

Objective To study the effect of different doses of atorvastatin on the incidence of adverse cardiac events in patients after percutaneous coronary intervention.Methods A total of 210 patients treated with selective percutaneous coronary intervention were divided by random number table method into low-dose group,medium-dose group and high-dose group,with 70 cases in each group.Low-dose group,medium-dose group and high-dose group respectively received 20,40 and 60 mg of atorvastatin by oral administration at 12 h before intervention therapy.The levels of creatine kinase isoenzyme（CK-MB）,cardiac troponin I（CTNI）,hypersensitive C reactive protein（hs-CRP） and endothelin（ET） in three groups before operation and 24 h after operation were measured.The patients were followed up for 1 month,and the cardiac adverse events such as myocardial infarction,cardiogenic shock death and target vessel revascularization again were counted.Results Three groups had obviously higher CK-MB and CTNI level in 24 h after operation than before operation,and the difference was statistically significant（P〈0.05）.High-dose group and medium-dose group had obviously lower CK-MB and CTNI level in 24 h after operation than low-dose group（P〈0.05）.High-dose group had obviously lower CK-MB and CTNI level in 24 h after operation than medium-dose group（P〈0.05）.High-dose group had obviously lower hsCRP and ET level in 24 h after operation than medium-dose group and low-dose group（P〈0.05）.Medium-dose group and low-dose group had no statistically significant difference in hs-CRP and ET level in 24 h after operation（P〉0.05）.After 1 month of follow-up after operation,high-dose group had obviously lower incidence of adverse cardiac events as 2.9% than 20.0% and 14.3% in low-dose group and medium-dose group,and the difference was statistically significant（P〈0.05）.Conclusion Application of 60 mg atorvastatin before percutaneous coronary intervention can significantly improve myocardial injury and inflammatory response and reduce the incidence of adverse cardiac events.