强化阿托伐他汀对冠状动脉介入治疗的心肌保护作用.docVIP

摘要】 目的 探讨经皮冠状动脉介入治疗（PCI）前给予强化他汀治疗对心肌损伤的保护作用及其临床应用价值。方法 100例不稳定型心绞痛患者随机分为他汀治疗组（51例）和对照组（49例），他汀治疗组在PCI前接受3～7 d的阿托伐他汀40 mg/d的治疗，对照组在PCI前不使用他汀类药物；两组患者均接受其他常规治疗，且在PCI后均接受他汀类药物治疗。比较他汀治疗组与对照组在PCI前后心肌损伤标记物及相关炎性标记物的变化；并通过1个月的随访，观察对患者主要心脏不良事件（预后）的影响。 结果 他汀治疗组PCI后血肌钙蛋白T（TnT）升高与肌酸激酶MB（CKMB）升高的发生率均为17.6%，低于对照组的24.5%和32.7%，但差异无统计学意义（P均0.05）；两组不良反应的发生率相似；PCI后两组患者血白细胞及高敏C反应蛋白的变化相似；随访1个月，两组均未发生死亡、心肌梗死及再次冠脉血运重建等主要心脏不良事件。 结论 PCI前给予强化他汀治疗的安全性良好，并有潜在降低PCI后心肌损伤发生的可能；他汀类药物对PCI前后白细胞及高敏C反应蛋白的变化无明显影响。 【关键词】 西司他汀类； 血管成形术，经腔，经皮冠状动脉； 心绞痛，不稳定型 The protection of atorvastatin to myocardium in patients with unstable angina during percutaneous transluminal coronary intervention therapy ZHANG Ruisheng, JI Fusui, HE Qing, SUN Fucheng, XU Feng. Department of Cardiology, Beijing Hospital, Beijing 100730, China Abstract: Objective To evaluate the protection effect of atorvastatin treatment to myocardium during percutaneous transluminal coronary intervention (PCI) in patients with unstable angina pectoris. Methods One hundred patients with unstable angina were randomized to atorvastatin group, who received atorvastatin 40 mg per day for 3 to 7 days, and control group, who did not receive statin therapy before PCI. All patients were given conventional treatment for coronary artery disease. Serum TnT, CKMB, and HsCRP were checked before and 24 hours after PCI in both groups. All the patients were followed 1 month for major adverse cardiac events. Results The rates of TnT and CKMB elevation were lower in atorvastatin group than in control group, but no statistical significance (17.6% vs. 24.5%, P0.05 and 17.6%vs. 32.7%, P0.05, respectively) was found. Seven patients in atorvastatin group and eight patients in control group (13.7% vs. 16.3%, P0.05) had ALT elevation, there is no severe adverse reaction in both group. The change of HsCRP after PCI in atorvastatin group was similar to that in control group (0.81±3.14 vs. －0.12±1.53, P0.05). During 1 month followup, there is no death