【摘要】 目的:探讨老年非ST段抬高急性冠状动脉综合征(NSTEACS)患者PCI术前负荷剂量瑞舒伐他汀治疗对血清凝集素样氧化低密度脂蛋白受体-1(Lox-1)高敏C反应蛋白(hs-CRP)及近期预后的影响。方法:将72例老年NSTEACS患者随机分为负荷治疗组33例和对照组39例,负荷治疗组PCI术前12 h顿服瑞舒伐他汀20 mg,PCI术前2 h追加瑞舒伐他汀20 mg。所有患者于术前、术后24 h、术后30 d抽取静脉血,检测Lox-1、hs-CRP、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白Ⅰ(c TnⅠ)等。随访30 d观察主要不良心脏事件发生率。结果:与术前比较,2组患者PCI术后24 h血清Lox-1、hs-CRP均明显升高(P<0.05),心肌损伤标志物CK-MB、c TnⅠ亦明显升高(P<0.01);但负荷治疗组Lox-1、hs-CRP、CK-MB、c TnⅠ升高幅度均显著低于对照组(P<0.05)。术后30 d负荷治疗组血清Lox-1、hs-CRP仍显著低于对照组(P<0.05)。与术前比较,术后24 h 2组患者血清总胆固醇(TC)及低密度脂蛋白胆固醇(LDL-C)水平均未见明显变化(P>0.05),术后30 d出现显著下降(P<0.05),但两组之间比较差异无统计学意义。与术前比较,2组患者PCI术后24 h、30 d血清ALT及Scr水平均未见明显升高。负荷治疗组主要不良心脏事件总发生率较对照组低(9.09%vs 28.21%,P<0.05)。结论:老年NSTEACS患者PCI术前负荷剂量瑞舒伐他汀能明显降低PCI术后Lox-1水平,减轻患者的心肌损伤及炎症反应,降低PCI术后近期不良心脏事件的发生率,其独立于他汀类药物调脂作用以外,且应用安全。更多还原

【Abstract】 Objective: To investigate the effect of loading-dose rosuvastatin on serum levels of lectin-like oxidized low-density lipoprotein receptor-1( Lox-1) and high-sensitivity c-reactive protein( hs-CRP) and recent prognosis in old patients with non-ST segment elevation acute coronary syndrome( NSTEACS) undergoing selected percutaneous coronary intervention. Methods: A total of 72 patients with non-ST segment elevation ACS were randomly divided into loading-dose group pretreated with rosuvastatin 20 mg 12 h before PCI and with a further 20 mg preprocedure dose( n = 33) and control group treated with standard dose( n = 39). Serum levels of Lox-1,hs-CRP,CK-MB and c TnⅠ were measured before and 24 h,30 d after the PCI. The 30-day incidence of major adverse cardiac events was recorded in both groups. Results: Compared with before PCI,serum levels of Lox-1 and hs-CRP of the two groups were elevated at 24 h after PCI( P < 0. 05),the levels of CK-MB and c Tn Ⅰ were also increased( P <0. 01),however,the values of Lox-1,hs-CRP,CK-MB and c TnⅠ were significantly lower in loading-dose group than those in control group. Serum levels of Lox-1 and hs-CRP were lower in loading-dose group than those in control group at 30 d after PCI( P < 0. 05). The levels of TC and LDL-C were not changed at 24 h after PCI( P > 0. 05)until 30 d after PCI( P < 0. 05),but there was no singnificantly difference between the two groups. The levels of ALT and Scr were not elevated in two groups before and after PCI. The 30-day incidence of MACE occurred in 9. 09% of patients in loading-dose group and in 28. 21% of the control group( P < 0. 05). Conclusion: The loading-dose rosuvastatin for old patients with non- ST segment elevation acute coronary syndromes undergoing selected percutaneous coronary intervention can attenuate the increase of serum levels of Lox-1,and reduce myocardial injury and inflammatory reaction caused by PCI,also reduce the occurrence of MACE in 30 d after PCI.更多还原