PCI术前单次不同负荷剂量阿托伐他汀对稳定型心绞痛患者的心肌保护作用

摘要

Objective To investigate the influence of once atorvastatin in different load doses on myocardium in patients with stable angina pectoris (SAP) before percutaneous coronary intervention (PCI). Methods SAP patients with selected PCI (n=106, male 72, female 34 and aged from 42 to 78) were chosen from Jun. 2013 to Dec. 2014, and randomly divided into group A (n=35), group B (n=35) and group C (n=36). All groups were given atorvastatin orally 8-12 h before PCI (group A: 20 mg, group B: 40 mg and group C: 80 mg). The changes of creatine kinase MB (CK-MB), cardiac troponin T (cTnT), high-sensitivity C-reactive protein (hs-CRP) and alanine aminotransferase (ALT) were detected in 3 groups before and 8 h and 24 h after PCI. Results The levels of CK-MB, cTnT and hs-CRP increased in group A 8 h and 24 h after PCI, and increased in group B and group C 24 h after PCI (all P<0.05). Compared with group A, the levels of CK-MB and cTnT decreased in group B and group C 24 h after PCI (all P<0.05). Compared with group B, the levels of CK-MB, cTnT and hs-CRP decreased in group C 24 h after PCI (all P<0.05). The change of level of ALT was not significant in 3 groups (all P>0.05). Conclusion For SAP patients without taking statins for long time, atorvastatin in dose of 80 mg given before PCI has better myocardial protective effect than that in dose of 20 mg or in dose of 40 mg.%目的：探讨稳定型心绞痛患者PCI术前给予单次不同负荷剂量阿托伐他汀对心肌保护的影响。方法入选2013年6月至2014年12月于常德市第一人民医院心血管内科住院并接受择期PCI手术的稳定型心绞痛患者106例，男性72例，女性34例，年龄42～78岁。随机分为3组，A组（35例），B组（35例），C组（36例）。PCI术前8~12 h服用阿托伐他汀，剂量分别为A组20 mg，B组40 mg，C组80 mg。检测3组患者术前和术后8 h、24 h肌酸激酶同工酶（CK-MB）、心肌肌钙蛋白T（cTnT）、高敏C反应蛋白（hs-CRP）、谷丙转氨酶（ALT）等指标变化。结果 A组术后8 h和24 h较术前CK-MB、cTnT、hs-CRP均升高，B组和C组术后24 h较术前CK-MB、cTnT、hs-CRP均升高，差异有统计学意义（P均＜0.05）。与A组比较，B组和C组术后24 h CK-MB、cTnT降低，差异有统计学意义（P均＜0.05）。与B组比较，C组术后24 h CK-MB、cTnT、hs-CRP降低，差异有统计学意义（P均＜0.05）。三组ALT无明显变化，差异无统计学意义（P均＞0.05）。结论未长期服用他汀类药物的稳定型心绞痛患者PCI术前给予80 mg阿托伐他汀对心肌保护作用优于20 mg和40 mg。