不同剂量阿托伐他汀对急性心肌梗死并高尿酸血症患者的疗效

摘要

目的:探讨不同剂量阿托伐他汀对急性心肌梗死并高尿酸血症患者经皮冠状动脉介入治疗(PCI)术后血脂、血尿酸(SUA)、高敏C反应蛋白(hsCRP)、心脏不良事件的影响及安全性.方法:62例接受急诊PCI的急性ST段抬高心肌梗死并高尿酸血症患者被随机分为:A组(32例)、B组(30例).两组患者术前均给予阿托伐他汀钙80mg顿服,A组术后给予阿托伐他汀钙40mg 1次/d口服,1个月后转为20mg 1次/d长期口服.B组术后给予20mg 1次/日长期口服.于术前、术后72h、1周、1月测定SUA、hsCRP,术前、术后1月测定血脂、肝功、肌酸激酶、随访心脏不良事件.结果:入院时两组SUA、hsCRP、血脂之间差异无显著性(P＞0.05).两组术后72h、1周、1月SUA水平逐渐下降,A组较B组降低更明显[1月后:(306.88±46.03)mmol/L比(365.90±35.47)mmol/L,P＜0.05].两组术后72h hsCRP水平均较入院时明显升高(P＜0.05),术后1周、1月逐渐降低,A组较B组降低更明显[1月后:(2.10±1.29)mg/L比(3.55±0.63)mg/L,P＜0.05].两组术后血脂水平无明显差异(P＞0.05).A组心脏不良事件发生率明显低于B组(0比6.6％,P＜0.05).两组无病例出现严重肝功损害和肌痛等现象.结论:大剂量阿托伐他汀能明显降低血尿酸、高敏C反应蛋白水平、降低炎性反应,改善内皮功能,减少心脏不良事件的发生,安全性好.%Objective: To investigate effects and safety of different doses of atorvastatin on levels of blood lipids, serum uric acid (SUA), high sensitive C reactive protein (hsCRP) and adverse cardiac events in patients with acute my-ocardial infarction (AMI) complicated hyperuricemia (HUA) after percutaneous coronary intervention (PCI). Methods: A total of 62 HUA patients with acute ST segment elevation myocardial infarction undergoing emergency PCI were randomly divided into group A (n = 32) and group B (n = 30). Both groups received 80mg atorvastatin once before PCI. After PCI, group A received 40mg atorvastatin once a day oral for one month, then 20mg once a day oral for long term; group B received 20mg atorvastatin once a day oral for long term. SUA and hsCRP were measured before, 72h, one week and one month after PCI. Blood lipids, liver function, creatine kinase (CK) were measured before and one month after PCI, and adverse cardiac event was followed up. Results: When admitted, there were no significant difference in SUA, hsCRP and blood lipids between two groups (P>0. 05). On 72h, one week and one month after PCI, SUA level gradually decreased in two groups, and that of group A was significantly lower than that of group B [after one month: (306. 88 ± 46. 03) mmol/L vs. (365.90 + 35.47) mmol/L, P<0. 05]. On 72h after PCI, hsCRP levels in two groups were significantly higher than those at admission (P<0. 05), and gradually decreased after one week and one month, and that of group A was significantly lower than that of group B [after one month: (2.10 ±1.29) mg/Lvs. (3. 55 ± 0. 63) mg/L, P<0. 05]. There were no significant difference in levels of blood lipids between two groups after PCI (P>0. 05). Incidence rate of adverse cardiac events in group A was significantly lower than that of group B (0 vs. 6. 6%, P<0. 05). No severe liver function injury and myalgia occurred in two groups. Conclusion: High- dose atorvastatin could significantly decrease levels of serum uric acid, high sensitive C - reactive protein and inflammatory reaction, improve endothelial function, decrease incidence of adverse cardiac events and is safe.