瑞舒伐他汀强化治疗对急性冠脉综合征血运重建术后血脂及C反应蛋白的影响

摘要

Objective: To evaluate the effect of rosuvastatin intensive therapy on serum levels of high-sensitivity C—reactive protein (hs — CRP) and low-density lipoprotein-cholesterol (LDL-C) in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods; A total of 60 ACS patients were randomly divided into two groups, rosuvastatin intensive therapy group (intensive therapy group, n=30) and conventional therapy group (n=30) . Based on standard treatment, patients in intensive therapy group were given rosuvastatin l0mg/d o-ral and in conventional therapy group were given rosuvastatin 5mg/d oral. The serum levels of hs—CRP and LDL-C of the two groups were compared and analyzed before PCI, and 24 h, four weeks, eight weeks, 12 weeks after PCI. Results: (1) There was no significant differences between the two groups in LDL-C level before PCI, 24h, eight weeks and 12 weeks after PCI (P＞0. 05 all). On four weeks, LDL-C level of intensive therapy group was significantly lower than that of conventional therapy group [ (2. 92±0. 47) mmol/L vs. (3. 65±0. 39) mmol/L, P＜0. 05]. (2) No significant differences existed between the two groups in serum hs—CRP level before PCI, eight weeks and 12 weeks after PCI (P＞0. 05 all) . At 24h after PCI, serum levels of hs—CRP in both groups were significantly higher than those before PCI [intensive therapy group: (17. 38 ±2. 98) mg/L vs. (14. 21 ±2. 50＞ mg/L, conventional therapy group (17.12±2. 02) mg/L vs. (13. 30±l. 97) mg/L, P＜0. 01 both]. On four weeks after PCI, hs—CRP level of intensive therapy group was significantly lower than that of conventional therapy group [ (7. 22±0. 89) mg/L vs. (10. 12±1. 43) mg/L, P＜0. 01]. (3) Cardiac troponin I (cTnI) level increase in four weeks: there was four cases (14. 8％) for conventional therapy group and one case (3. 6％) for intensive therapy group. Conclusion: Rosuvastatin intensive therapy can earlier relieve inflammation and lower serum LDL-C level in ACS patients after PCI. And it' s helpful to decrease occurrence rates of cardiovascular events after PCI. Twelve weeks could be regarded as a dose-changing time window of rosuvastatin therapy in ACS patients after PCI.%目的:评价瑞舒伐他汀强化治疗对急性冠脉综合征(ACS)患者经皮冠状动脉介入治疗(PCI)术后血清低密度脂蛋白-胆固醇(LDL-C)和高敏C反应蛋白(hs-CRP)水平的影响.方法:60例ACS患者.随机分为瑞舒伐他汀强化治疗组(简称强化治疗组,30例)和常规治疗组(30例),强化治疗组患者在标准治疗基础上每日服用瑞舒伐他汀10mg,常规治疗组患者在标准治疗基础上每日服用瑞舒伐他汀5mg.入院后4h至10d行冠状动脉支架植入治疗.比较两组病人PCI治疗前、治疗后24h、4周、8周和12周血清LDL-C和hs-CRY水平,观察病人血清转氨酶和肌酸激酶(CK)变化.结果:(1)两组PCI术前及PCI术后24h、8周、12周LDL-C水平均无显著性差异(P均>0.05),PCI术后4周强化治疗组LDL-C水平明显低于常规治疗组[(2.92±0.47)mmol/L比(3.65±0.39)mmol/L,P<0.05];(2)两组术前及术后8周、12周血清hs-CRP水平无显著性差异(P均>0.05),两组PCI术后24hhs-CRP均明显高于术前[强化治疗组(17.38±2.98)mg/L比(14.21±2.50 mg/L),常规治疗组(17.12±2.02)mg/L比(13.30±1.97)mg/L,P<0.01],强化治疗组术后4周hs-CRP水平明显低于常规治疗组[(7.22±0.89)mg/L比(10.12±1.43)mg/L,P<0.01];(3)在4周心脏肌钙蛋白I(cTnI)水平升高:常规治疗组4例(14.8%),强化治疗组1例(3.6%),结论:瑞舒伐他汀强化治疗能够更早降低急性冠脉综合征病人PCI术后炎症反应和血清低密度脂蛋白胆固醇水平,有助于减少患者PCI术后心血管事件发生率.12周可以作为急性冠脉综合征病人接受PCI后瑞舒伐他汀强化治疗与常规治疗的剂量转换时间窗.