瑞舒伐他汀对急性STEMI冠脉介入治疗后存活心肌功能及动脉粥样硬化的影响

摘要

目的:探讨瑞舒伐他汀作为新型他汀类药物对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后存活心肌功能及动脉粥样硬化的影响.方法:65例STEMI患者被随机分为辛伐他汀组(32例)和瑞舒伐他汀组(10mg,睡前服,33例),随访12个月,测定患者在介入前、后12个月的血脂及血浆C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)水平,并观察颈动脉内膜中层厚度(IMT)及99m锝-甲氧基异丁基异腈(89mm Tc-MIBI)摄取分数的改变.结果:两组患者治疗12个月后,总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、CRP及TNF-α水平均有显著下降(P＜0.05～＜0.01),而99mTc-MIBI摄取分数均显著增加;且与辛伐他汀组比较,瑞舒伐他汀组治疗后TC[(4.54±0.66)mmol/L比(3.21±0.53)mmol/L]、LDL-C[ (2.71±0.53)mmol/L比(2.01±0.34) mmol/L]、CRP[(0.41±0.15)mg/ml比(0.28±0.13) mg/ml]、TNF-α[(1.48±1.15) ng/ml比(1.05±0.91)ng/ml]水平明显降低及99mTc-MIBI摄取分数[(1.66±0.38)比(1.99±0.46)]明显增加(P＜0.05).瑞舒伐他汀组患者治疗后IMT较治疗前明显减小[(0.81±0.27)mm比(0.98±0.41)mm,P＜0.01],且优于辛伐他汀组[(0.81±0.27) mm比(0.93±0.33)mm],而辛伐他汀组IMT无明显变化(P＞0.05).结论:在PCI术及常规药物基础上加用瑞舒伐他汀可使急性ST段抬高型心肌梗死患者颈动脉内膜中层厚度明显减小,并进一步改善存活心肌细胞功能.%To study influence of rosuvastatin on function of survival myocardium and arteriosclerosis in patients with acute ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). Methods: A total of 65 STEMI patients were randomly divided into simvastatin group (n = 32) and rosuvastatin group (n = 33, received rosuvastatin 10mg/d before sleep). All patients were followed up for 12 months. Levels of blood lipids. plasma C reactive protein (CRP) and tumor necrosis factor-α (TNF-α) were measured in all patients before and 12 months after PCI. Changes of carotid intima-media thickness (IMT) and intake fraction of 99mTc-methoxy isobutyl isonitrile (99mTc-MIBD were observed in two groups. Results: After 12 - month treatment, there were significant decrease in levels of total cholesterol (TO. low density lipoprotein-cholesterol (LDL-C). CRP and TNF-α (P<0. 05~<0. 01), and significant increase in intake fraction of 99mTc-MIBI in both groupsi compared with simvastatin group, there were significant decrease in levels of TC [ (4. 54 ± 0. 66) mmol/L vs. (3.21 ± 0.53) mmol/L], LDL-C [ (2.71 ± 0. 53) mmol/L vs. (2.01 ± 0. 34) mmol/L], CRP [ (0.41 ± 0.15) mg/ml vs. (0.28 + 0.13) mg/ml] and TNF-α[ (1.48 ±1.15) ng/ml vs. (1.05±0.91) ng/ml], and significant increase in intake fraction of 99mTc-MIBI [ (1.66± 0. 38) vs. (1.99 ± 0.46)] in rosuvastatin group after treatment, P<0.05 all. Compared with before treatment, there was significant decrease in IMT [ (0.98±0.41) mm vs. (0,81 ±0.27) mm. P<0. 01] , and was significantly lower than that of simvastatin group [ (0. 81 ± 0. 27) mm vs. (0. 93 ± 0. 33) mm] in rosuvastatin group after treatment. Conclusion: Rosuvastatin therapy based on routine drug and percutaneous coronary intervention can significantly decrease intima-media thickness and further improve cellular function of survival myocardium in patients with acute ST segment elevation myocardial infarction.