瑞舒伐他汀与阿托伐他汀对急性心肌梗死患者心肌纤维化干预的对照研究

Controlled study on rosuvastatin and atorvastatin in intervention of myocardial fibrosis in patients with acute myocardial infarction

目的探讨不同类型、不同剂量的他汀类药物对急性心肌梗死(AMI)患者心肌纤维化干预的效果,找到更为安全可靠的AMI治疗药物。方法选取中国中医科学院望京医院2016年2月—2018年1月收治的AMI患者160例,根据随机数字表法分为4组,各40例。A组采用常规剂量阿托伐他汀(20 mg/次,1次/d),B组采用负荷剂量阿托伐他汀(40 mg/次,1次/d),C组采用常规剂量瑞舒伐他汀(10 mg/次,1次/d),D组采用负荷剂量瑞舒伐他汀(20 mg/次,1次/d)。治疗前、治疗1周、治疗4周,分别检测并比较4组患者血脂指标、炎性指标[超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)]、心肌纤维化指标[转化生长因子β1(TGF-β1)、Ⅰ型前胶原羟基末端肽(PICP)、半乳凝素-3(Gal-3)、结缔组织生长因子(CTGF)、Ⅲ型前胶原氨基端肽(PⅢNP)及Ⅰ型胶原羟基末端肽(ⅠCTP)],同时观察安全性。结果治疗前,4组患者血脂指标、炎性指标、心肌纤维化指标水平比较,差异均无统计学意义;治疗1、4周后,4组患者血脂指标、炎性指标均改善,且D组改善最为显著,与其他3组比较,差异有统计学意义(P<0.05);治疗1周,4组患者心肌纤维化指标水平均升高,且A组升高最为显著(P<0.05);治疗4周后,4组患者各心肌纤维化指标水平均较治疗1周有降低,但D组降低幅度最为显著,后依次为C组、B组、A组,组间比较差异有统计学意义(P<0.05)。全部患者在治疗期间均未发生明显不良反应。结论瑞舒伐他汀对AMI患者血脂、炎性反应、心肌纤维化的影响较阿托伐他汀更佳,在为患者加大负荷剂量后,心肌纤维化改善效果提升,药物毒副反应未增加,故在AMI耐受的条件下可为其使用大剂量瑞舒伐他汀治疗。

Objective To investigate the effects of different types and doses of statins in the intervention of myocardial fibrosis in patients with acute myocardial infarction(AMI),and to find more safe and reliable drugs for AMI.Methods 160 AMI patients in the hospital from February 2016 to January 2018 were selected,and they were divided into four group by random number table,with 40 cases in each group.A group:routine dose of atorvastatin(20 mg,once a day),B group:loading dose of atorvastatin(40 mg,once a day),C group:routine dose of rosuvastatin(10 mg,once a day),D group:loading dose of rosuvastatin(20 mg,once a day).The blood lipid indexes[total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDLC)],inflammatory indexes[hypersensitive C reactive protein(hs-CRP),interleukin-6(IL-6)],myocardial fibrosis indexes[transforming growth factor-β1(TGF-β1),procollagenⅠC-terminal peptide(PⅠCP),galectin-3(Gal-3),connective tissue growth factor(CTGF),type III procollagen amino terminal peptide(PⅢNP),type I collagen hydroxy terminal peptide(ⅠCTP)]in four groups before treatment,after treatment for 1 w and 4 w were compared.The safety of four groups were observed.Results Before treatment,there was no statistical difference in the blood lipid indexes,inflammatory indexes and myocardial fibrosis indexes among the four groups.After treatment for 1 w and 4 weeks,the blood lipid indexes and inflammatory indexes in four groups improved,and D group improved more significantly compared with other three groups(P<0.05).After treatment for 1 w,the levels of myocardial fibrosis indexes in four groups increased,and A group increased more significantly;After treatment for 4 w,the levels of myocardial fibrosis indexes in four groups decreased compared with those after treatment for 1 w,but the decreased range of D group was the most significant,followed by C group,B group and A group(P<0.05).There were no obvious adverse reactions during treatment.Conclusion Rosuvastatin has better influence on blood lipid,inflammatory response,myocardial fibrosis of AMI patients than atorvastatin.After the application of loading dose,it can improve myocardial fibrosis and not add toxic-side reactions.Therefore,large dose of rosuvastatin can be used for the treatment of AMI under the patients’tolerance.