经皮冠状动脉介入治疗术前单次负荷剂量与常规剂量瑞舒伐他汀对冠心病患者预后的影响

PCI preoperative single load dose and conventional dose risuvastatin on prognosis of patients with coronary heart disease

目的探讨经皮冠状动脉介入治疗(PCI)术前单次负荷剂量与常规剂量瑞舒伐他汀对冠心病患者预后的影响。方法选取我院接受PCI介入诊治的患者108例,随机分为常规组和负荷组,每组各54例,分别在术前12小时使用常规剂量和负荷剂量的瑞舒伐他汀,常规剂量为5mg,负荷剂量为20mg,术后均使用常规剂量5mg连续服用。收集所有患者在PCI术前的基线资料,检测术后心肌指标物,并进行随访。观察比较其各项指标的变化情况、主要不良心血管事件(MACE)及瑞舒伐他汀的肝毒性和肌毒性发生情况并进行率的比较。结果心肌指标物心肌肌钙蛋白T(cTnT)、单核细胞趋化蛋白1(MCP-1)、C反应蛋白(CRP)、肌酸激酶同工酶(CK-MB)在术后24小时、7天的测量水平均较术前有所上升,两组比较差异有统计学意义(P<0.05);随访记录术后30天内MACE及瑞舒伐他汀的肝毒性和肌毒性发生情况,两组差异比较有统计学意义(P<0.05)。结论 PCI术前单次负荷剂量瑞舒伐他汀对冠心病患者预后具有积极意义,可以在术前使用负荷剂量他汀药物来减少术后心脏不良事件的发生。

Objective To investigate the effect of single loading dose and conventional dose of rosuvastatin on the prognosis of patients with coronary heart disease before and after percutaneous coronary intervention（PCI）.Methods Totally 108 patients who underwent PCI intervention in our hospital were randomly divided into conventional group（n=54,rosuvastatin 5 mg at 12 hpreoperatively）and loading group（n =54,rosuvastatin 20 mg at 12 h preoperatively）.After operation,all patients in two groups took contineously the conventional dose of rosuvastatin 5 mg.Basic clinical indexes,myocardial basic indicators and follow-up for the whole patients were detected before and after PCI.Meanwhile,changes in each index,major adverse cardiovascular events（MACE）,hepatotoxicity and myotoxicity of rosuvastatin were observed and compared.Incidence of MACE,hepatotoxicity and myotoxicity of rosuvastatin were compared respectively.Results The levels of myocardial markers,cardiac troponin T（cTnT）,monocyte chemotactic protein-1（MCP-1）,C reactive protein（CRP）and creatine kinase（CK-MB）at 24 hand 7 d postoperatively rose as compared with those before PCI,indicating statistically significant differences bewteen conventional group and loading group（P〈0.05）;Follow-up of MACE,hepatotoxicity and myotoxicity of rosuvastatin within 30 dand 1 year postoperatively were recorded and revealed statistically significant differences（P〈0.05）.Conclusion The single loading dose of rosuvastatin before PCI is of positive significance for the prognosis of patients with coronary heart disease.Moreover,application of loading dose of statins before operation can reduce postoperative adverse cardiac events.