不同剂量阿托伐他汀对心肌梗死患者PCI后相关指标及主要不良心血管事件的影响

摘要

OBJECTIVE:To investigate the effects of atorvastatin with different doses on related indicators and major adverse cardiovascular events(MACE)in patients with acute myocardial infarction(AMI)after percutaneous coronary intervention(PCI). METHODS:120 patients with AMI after PCI were randomly divided into conventional dose group(60 cases)and high dose group (60 cases). All patients were immediately given low molecular weight heparin,Aspirin enteric-coated tablet,Clopidogrel bisulfate tablet,Angiotensin-converting enzyme inhibitor,β-blockers,nitrates and other conventional treatment;based on it,conventional dose group was given 20 mg Atorvastatin calcium tablet,once every day before bedtime;high dose group was given 40 mg Atorv-astatin calcium tablet,once every day before bedtime. The treatment course for both groups was 1 month. Total cholesterol(TC), triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),C-reactive protein (CRP),OX40L,interleukin (IL)-6 levels in 2 groups before and after treatment were observed,the correlation among OX40L with CRP and IL-6 were analyzed,and the incidence of MACE in 2 groups was recorded after 1 month follow-up. RESULTS:Be-fore treatment,there were no significant differences in the TG,TC,LDL-C,HDL-C,OX40L,CRP and IL-6 between 2 groups (P>0.05). After treatment, TG, TC, LDL-C, OX40L, CRP and IL-6 were aignificantly lower than before, TC, LDL-C, OX40L,CRP and IL-6 in high dose group were lower than conventional dose group,HDL-C was significantly higher than before, the differences were statistically significant(P0.05). Before treatment,OX40L showed positive correlation with CRP(r=0.746,P<0.01)and IL-6(r=0.763,P<0.01);after treatment,OX40L also showed positive correlation with CRP (r=0.755,P<0.01) and IL-6 (r=0.760,P<0.01). The incidence of MACE in high dose group were significantly lower than conventional dose group,the difference was statistically significant(P<0.05). CONCLUSIONS:Based on the conventional treatment,atorvastatin can significantly reduce lipid,inflamma-tion levels and incidence of MACE,but the effect is more significant in high dose.%目的：探讨不同剂量阿托伐他汀对急性心肌梗死（AMI）患者行冠状动脉介入治疗（PCI）后相关指标及主要不良心血管事件（MACE）的影响。方法：120例AMI并成功施行PCI患者随机分为常规剂量组（60例）和大剂量组（60例）。两组患者确诊后均立即给予低分子肝素、阿司匹林肠溶片、硫酸氢氯吡格雷片、血管紧张素转换酶抑制剂、β受体阻滞药、硝酸酯类药物等常规治疗。在此基础上，常规剂量组患者给予阿托伐他汀钙片20 mg，每日睡前口服1次；大剂量组患者给予阿托伐他汀钙片40 mg，每日睡前口服1次。两组疗程均为1个月。观察两组患者治疗前后总胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、C反应蛋白（CRP）、血浆可溶性OX40配体（OX40L）、白细胞介素6（IL-6）水平，分析OX40L与CRP及IL-6的相关性，术后随访1个月记录两组患者MACE发生情况。结果：治疗前，两组患者TG、TC、LDL-C、HDL-C、CRP、OX40L、IL-6水平比较，差异均无统计学意义（P＞0.05）。治疗后，TG、TC、LDL-C、CRP、OX40L、IL-6水平均显著低于同组治疗前，且大剂量组TC、LDL-C、CRP、OX40L、IL-6水平低于常规剂量组，HDL-C水平均显著高于同组治疗前，差异均有统计学意义（P＜0.01或P＜0.05），但两组TG、HDL-C水平比较差异均无统计学意义（P＞0.05）。治疗前，两组患者OX40L与CRP（r＝0.746，P＜0.01）、IL-6（r＝0.763，P＜0.01）均呈正相关；治疗后，两组患者OX40L与CRP（r＝0.755，P＜0.01）、IL-6（r＝0.760，P＜0.01）亦呈正相关。大剂量组患者MACE发生率显著低于常规剂量组，差异有统计学意义（P＜0.05）。结论：在常规治疗的基础上，阿托伐他汀可显著降低患者血脂、炎症水平、MACE发生率，但大剂量时效果更加显著。