【摘要】 目的观察急性ST段抬高型心肌梗死(STEMI)急诊经皮冠状动脉介入治疗(PCI)术前80 mg阿托伐他汀治疗对患者术后6个月炎性因子及心功能的影响。方法连续入选STEMI患者163例,随机分为三组:A组(术前给予阿托伐他汀80 mg,术后给予40 mg/d,1个月后改为20 mg/d);B组(术前不服用阿托伐他汀,术后给予40 mg/d,1个月后改为20 mg/d);C组(术前不服用他汀类药物,术后给予阿托伐他汀20 mg/d)。三组患者分别于术前、术后7 d、1个月、6个月测定血清高敏C反应蛋白(hs-CRP)、B型脑钠肽(BNP)水平及三组术后2 d、3个月及6个月左心室舒张末内径(LVEDD)及左心室射血分数(LVEF)变化情况。结果三组患者术前hs-CRP及BNP水平无统计学差异;术后7 d时A组hs-CRP及BNP水平显著低于B组及C组(P<0.05),而B组与C组相比无统计学差异;术后1个月及6个月时,与C组相比,A组及B组hs-CRP及BNP水平显著下降,而A组又显著低于B组(P<0.05)。三组患者术后2 d及3个月LVEF组间比较无统计学差异;术后6个月时,与C组相比,A组及B组LVEF显著增高(P<0.05),而A组与B组之间无统计学差异。A组术后6个月LVEDD显著低于术后2 d,差异有统计学意义(P<0.05),B组及C组组内比较无统计学差异。结论 STEMI患者急诊PCI术前负荷剂量阿托伐他汀治疗可以早期并持久地降低血清hs-CRP及BNP水平,降低炎症反应,抑制激活的神经内分泌系统,3个月时可以显著改善左心室收缩功能,6个月时有效逆转心室重构。更多还原

【Abstract】 Objective To observe the effect of 80 mg atrovastatin on inflammatory cytokines and cardiac function before emergency percutaneous coronary intervention(PCI) in patients with ST elevation myocardial infarction(STEMI). Methods One hundred and sixty-three patients were randomly assigned to three groups: Group A: received atorvastatin 80 mg loading dose before PCI then followed by 40 mg daily for one month and a maintenance dose of 20 mg daily thereafter; Group B: received atorvastatin 40 mg daily after PCI for one month and a maintenance dose of 20 mg daily thereafter; Group C: received atorvastatin 20 mg daily after PCI. Determination of indicators:(1) high-sensitivity C-reactive protein(hs-CRP) and brain natriuretic factor or peptide(BNP) were detected pre-operation, post-operation 7th day, 1st and 6th month.(2) Left ventricular ejection fraction(LVEF) and left ventricular end-diastolic dimension(LVEDD) were detected at 2nd day, 3rd and 6th month after PCI. Results There were no significant differences in hs-CRP and BNP among three groups before PCI. 7 days after PCI, the hs-CRP and BNP levels in group A were significantly lower than those in group B and group C(P<0.05), while there were no significant differences between group B and group C. 1 and 6 months after PCI, the serum levels of hs-CRP and BNP were significantly lower in group A and group B than group C, while the serum levels of hs-CRP and BNP were significantly lower in group A than group B(P<0.05). There were no significant differences in LVEF among three groups in 2 days and 3 months after PCI. 6 months after PCI, the LVEF was significantly increased in group A and group B than group C(P<0.05). There was no significant difference in LVEF between group A and group B(P>0.05). The LVEDD was significantly decreased at 2 days than 6 months after PCI in group A, there were no significant differences in LVEDD between group B and group C(P>0.05). Conclusions Loading-dose atorvastatin therapy before emergency PCI could reduce the inflammatory response and inhibit the activation of the neuroendocrine system. It also could improve cardiac function in 3 months after PCI and reverse ventricular remodeling in 6 months after PCI.更多还原