不同剂量阿托伐他汀对急性冠脉综合征患者介入治疗后炎症及凝血因子的影响

摘要

目的 观察国人急性冠脉综合征(ACS)患者经皮冠脉介入术(PCI)围术期阿托伐他汀40 mg/d对炎症和凝血因子的影响.方法 入选100例ACS患者分为A、B两组.A组(常规治疗组)50例给予阿托伐他汀剂量20 mg/d,B组(强化治疗组)50例给予阿托伐他汀剂量40 mg/d,用药自PCI术前至术后1个月.于PCI术前及术后5、30 d测定超敏C反应蛋白(hs-CRP)、组织因子(TF)和组织因子途径抑制物(TFPI).结果 (1)两组PCI术后5 d hs-CRP水平均明显升高(P＜0.01),A组升高显著(P<0.01);调脂治疗30 d两组hs-CRP水平均较术前降低(P<0.01),B组降低更显著,(P<0.01).(2)A组PCI术后5 d TF升高(P＜0.01),调脂治疗30 d后恢复至PCI术前水平(P＞0.05);而B组PCI术后5 d TF无变化(P＞0.05),调脂治疗30 d后TF较术前降低(P<0.01).(3)A组PCI术后5 d TFPI升高(P＜0.05),调脂治疗30 d后恢复至术前水平(P＞0.05);B组PCI术后5 d TFPI较术前无变化(P＞0.05),PCI术后30 d TFPI较术前显著升高(P＜0.01).结论 阿托伐他汀40 mg/d能有效抑制ACS患者PCI术后炎性反应和调节TF/TFPI系统恢复平衡.%Objective To evaluate the effects of atorvastatin(40 mg/d)on inflammation and clotting factors in acute coronary syndrome(ACS)patients after percutaneous coronary intervention(PCI)treatment. Methods A total of 100 patients with ACS were enrolled and assigned into 2 groups: Group A(conventional treatment group ), in which 50 patients were treated with atorvastatin of 20 mg/d; Group B(intensive treatment group ), 50 patients received atorvastatin of 40 mg/d. Continuous drug treatment was given before PCI, until 1 month after the procedure. Blood samples were collected before PCI, and 5 and 30 days after PCI. Results (1) Significant increases of hs-CRP were revealed in both groups 5 days after PCI(P <0. 01 ), with significantly more prominence in Group A(P <0. 01 ). However, significant reductions of hs-CRP were revealed in both groups 30 days after PCI, with significantly more prominence in Group B(P <0. 01 ).(2)Although significant increase of TF was observed 5 days after PCI in Group A(P <0. 01 ), it returned to baseline level 30 days after PCI. No significant change of TF was observed in Group B 5 days after PCI(P > 0. 05 ). Furthermore, significant reduction of TF was revealed 30 days after PCI(P <0. 01 ).(3)Although significant increase of TFPI was observed 5 days after PCI in Group A(P < 0. 01 ), it returned to baseline level 30 days after PCI. No significant change of TFPI was observed in Group B 5 days after PCI(P >0. 05 ), furthermore, significant increase of TF was revealed 30 days after PCI(P <0. 01 ). Conclusion Atorvastatin(40 mg/d)effectively suppresses the inflammatory responses and balances TF/TFPI system in patients with ACS.