阿托伐他汀对老年非ST段抬高型急性冠脉综合征患者PCI的心肌保护作用

Myocardial protection effects of atorvastatin on aged NSTEACS patients during PCI

目的:探讨不同剂量阿托伐他汀对老年非ST段抬高型急性冠脉综合征(NSTEACS)患者冠状动脉介入治疗(PCI)术的心肌保护作用。方法:选择我院收治的择期行PCI术的老年NSTEACS患者92例作为研究对象,按照随机数字表法分为阿托伐他汀标准剂量组(术前3d 20mg/次,1次/d)和大剂量组(术前3d 40mg/次,1次/d),各46例;两组术前均接受常规治疗。观察比较两组术前后心肌肌钙蛋白Ⅰ(cTnⅠ)和肌酸激酶同工酶(CKMB)、高敏C反应蛋白(hsCRP)、白细胞介素6(IL-6)以及可溶性细胞间粘附分子1(sICAM-1)水平并统计心脏不良事件发生率。结果:与术前比较,术后两组cTnⅠ、CK-MB、hsCRP、IL-6、sICAM-1水平均显著升高(P均=0.001),且与标准剂量组比较,大剂量组cTnⅠ[(1.93±0.35)ng/ml比(1.54±0.32)ng/ml]、CK-MB[(2.79±0.52)ng/ml比(2.31±0.46)ng/ml]、hsCRP[(18.54±3.50)mg/L比(15.67±3.22)mg/L]、IL-6[(35.59±6.47)ng/ml比(32.41±6.54)ng/ml]、sICAM-1[(329.76±54.18)μg/L比(305.35±54.24)μg/L]水平显著降低(P<0.05或<0.01);心脏不良事件发生率明显降低(4.35%比21.74%,P=0.03)。结论:老年NSTEACS患者PCI术前给予40mg阿托伐他汀较20mg阿托伐他汀,抗炎、保护心肌效果更确切,能够显著降低术后心脏不良事件发生率。

Objective:To explore myocardial protection effects of different doses of atorvastatin on aged patients with non-ST elevation acute coronary syndrome(NSTEACS)during percutaneous coronary intervention(PCI).Methods:A total of 92 aged NSTEACS patients undergoing selective PCI in our hospital were selected.They were randomly and equally divided into standard dose group(received atorvastatin 20mg/time,once a day for 3d before PCI)and large dose group(received atorvastatin 40mg/time,once a day for 3d before PCI).Both groups all received routine treatment before PCI.Levels of cardiac troponin I(cTnI)and creatine kinase isoenzyme MB(CK-MB),high sensitive C reactive protein(hsCRP),interleukin-6(IL-6)and soluble intercellular adhesion molecule-1(sICAM-1)before and after PCI,and incidence rate of adverse cardiac events were observed and compared between two groups.Results:Compared with before PCI,there were significant rise in levels of cTnI,CK-MB,hsCRP,IL-6 and sICAM-1 in two groups after PCI,P=0.001 all.Compared with standard dose group after PCI,there were significant reductions in levels of cTnI[(1.93±0.35)ng/ml vs.(1.54±0.32)ng/ml],CK-MB[(2.79±0.52)ng/ml vs.(2.31±0.46)ng/ml],hsCRP[(18.54±3.50)mg/L vs.(15.67±3.22)mg/L],IL-6[(35.59±6.47)ng/ml vs.(32.41±6.54)ng/ml]and sICAM-1[(329.76±54.18)μg/L vs.(305.35±54.24)μg/L];incidence rate of adverse cardiac events(4.35%vs.21.74%,P=0.03)in large dose group,P<0.05 or<0.01;Conclusion:Compared with preoperative 20mg atorvastatin therapy,40mg atorvastatin therapy before PCI possesses more significant anti-inflammation and myocardial protection effect,and can significantly reduce postoperative incidence rate of adverse cardiac events in aged NSTEACS patients.