老年冠心病患者经皮冠状动脉介入治疗术前负荷剂量他汀治疗的有效性与安全性

摘要

Objective To explore the efficacy and safety of loading dose of statin treatment before percutaneous coronary intervention(PCI)on elderly patients with coronary heart disease.Methods According to the dose of statins treatment,176 patients underwent PCI were divided into conventional treatment group(n=95)and loading treatment group(n=81).Patients in conventional treatment group and loading treatment group were treated with loading dose and moderate intensity of statins 12-24 h before PCI respectively,and were both treated with moderate intensity of statins to maintain treatment from the second day after PCI and optimized drug treatment plans according to patients'condition.Incidence of myocardial infarction related to PCI(pMI)and contrast-induced nephropathy(CIN)24 h after PCI, changes of serum lipid and liver function,occurrence of new glucose abnormalities and so on were compared. Results Incidence of pMI and CIN 24 h after PCI in conventional treatment group and loading treatment group(56.5% and 59.7%,4.3% and 3.8%)were not significantly different(P>0.05).Compared with the level of cystatin C(Cys C)before PCI,serum Cys C 24 h after PCI decreased in both two groups(P<0.001). Compliance rate of low-density lipoprotein cholesterol control,level of serum ALT and AST 3 months after PCI between the two groups were not significantly different(P >0. 05). There were no patients and 3 patients with new glucose abnormalities in conventional treatment and loading treatment group respectively. ConclusionLoading dose of statin treatment before PCI in elderly patients with coronary heart disease has no significant effects on reducing the incidence of pMI and CIN and there is no significant difference in the incidence of adverse events between loading dose and moderate intensit of statin treatment.%目的 探讨老年冠心病患者经皮冠状动脉介入治疗(PCI)术前负荷剂量他汀治疗的有效性及安全性.方法 依据PCI术前他汀治疗剂量,将176例接受PCI的老年冠心病患者分为常规治疗组95例和负荷治疗组81例.常规治疗组和负荷治疗组患者PCI术前12~24 h内分别接受中等强度和负荷剂量他汀治疗,从术后第2天开始均接受中等强度他汀维持治疗,并均根据病情接受冠心病优化药物治疗方案.比较两组患者PCI术后24 h PCI相关性心肌梗死(pMI)、对比剂肾病(CIN)的发生率及治疗3个月后血脂、肝功能、新发血糖异常情况等.结果 常规治疗组和负荷治疗组患者PCI术后24 h pMI的发生率分别为56.5%和59.7%、CIN的发生率分别为4.3%和3.8%,差异均无统计学意义(P>0.05).与PCI术前胱抑素C(Cys C)基线水平比较,两组患者术后24 h血清Cys C水平均降低(P<0.001).两组患者术后3个月低密度脂蛋白胆固醇控制达标率、血清ALT、AST水平比较,差异均无统计学意义(P>0.05).常规治疗组未出现新发血糖异常者,负荷治疗组有3例患者出现新发血糖异常.结论 老年冠心病患者PCI术前负荷剂量他汀治疗对降低pMI及CIN的发生率无显著影响,PCI术前负荷剂量和中等强度他汀治疗对其不良反应发生率无显著差异.