不同剂量辛伐他汀对急性ST段抬高型心肌梗死患者PCI术后左心功能及短期预后的影响

摘要

Objective To discuss the influences of simvastatin on left ventricular function and short-term outcomes in patients with acute ST-segment elevation myocardial infarction ( STEMI ) after percutaneous coronary intervention (PCI) . Methods The patients ( n=125 ) with STEMI were randomly divided into standard treatment group of simvastatin ( 20 mg/d, standard group, n=62 ) and intensive treatment group of simvastatinrn( 40 mg/d, intensive group, n=63 ) . Before PCI and 6 months after treatment, the levels of total cholesterolrn( TC ) , triglyceride ( TG ) , low—density lipoprotein—cholesterol ( LDL-C ) , high-sensitivity C—reactive protein ( hs—CRP ) and N—terminal pro brain natriuretic peptide ( NT—proBNP ) were detected. The indexes of left ventricular ejection fraction ( LVEF ) , left ventricular mass index ( LVMI ) , left ventrieular end—diastolic diameter ( LVEDD ) , interseptal ventricular septal thickness (IVST ) , left ventricular posterior wall thicknessrn( LVPWT ) , and ratio of mitral valve peak flow velocities during early diastole and atrial systole ( E/A ) were examined by using Doppler echocardiography. At the same time, the incidence of major adverse cardiovascular events ( MACE ) was recorded during hospitalization and within 6 months during treatment. Results After treatment for 6 months, the levels of TC, TG, LDL-C, hs-CRP and NT-proBNP, and indexes of LVEDD, LVMI and LVPWT were all lower significantly ( P<0.05 ) , and indexes of LVEF, IVST and E/A were all higher significantlyrn( P<0.05 ) in intensive group than those in standard group. The incidence of MACE was lower in intensive group than that in standard group ( 4.76% vs. 11.29%, P<0.05 ) during treatment. Conclusion The intensive treatment of simvastatin can significantly improve left ventricular function and short—term outcomes in the patients with STEMI after PCI.%目的 探讨辛伐他汀对急性ST段抬高型心肌梗死(STEMI)患者经皮冠状动脉介入治疗(PCI)后左心功能以及短期预后的影响.方法 纳入125例STEMI患者,随机分为辛伐他汀标准治疗组(n=62,20mg/d)和强化治疗组(n=63,40mg/d),分别在介入治疗前和治疗后6个月测定血清胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高敏C反应蛋白(hs-CRP)、N端B脑钠肽前体(NT-proBNP)水平,并采用彩色多普勒超声检测左心室射血分数(LVEF)、左心室质量指数(LVMI)、左室舒张末期内径(LVEDD)、室间隔厚度(IVST)、左室后壁厚度(LVPWT)、二尖瓣口舒张早期最大流速和舒张末期最大流速比率(E/A);同时记录住院期间和随疗期间6月内主要心血管事件(MACEs)的发生率.结果 治疗6个月后强化治疗组TC、TG、LDL-C、hs-CRP、NT-proBNP、LVEDD、LVMI、LVPWT均显著低于标准治疗组(P＜0.05);LVEF、IVST、E/A比值显著高于标准治疗组(P＜0.05).治疗期间强化治疗组MACEs发生率低于标准治疗组(4.76% vs.11.29%,P＜0.05).结论 辛伐他汀强化治疗可显著改善STEMI患者PCI术后的左心功能和短期预后.