强化他汀治疗对经皮冠状动脉介入术患者冠状动脉无复流及血浆相关因子的影响

摘要

目的 研究强化他汀治疗对择期经皮冠状动脉介入术( PCI)患者术中无复流发生率及血浆脂联素( APN)、高敏C反应蛋白(hs-CRP)的影响.方法 84例择期PCI患者随机分为强化他汀组及常规他汀组,强化他汀组患者在术前2天给予阿托伐他汀80 mg/d进行预处理,术后给予阿托伐他汀40 mg/d,1个月.常规他汀组患者术前2天给予阿托伐他汀20 mg/d,术后给予阿托伐他汀20 mg/d,共用1个月.分别检测术前、术后及术后1个月、3个月两组患者的APN、hs-CRP、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)水平；观察术中无复流现象发生率及主要终点.结果 30天内两组患者均未出现重大不良心血管事件,两组患者LDL-C、hs-CRP水平均降低,APN、HDL-C水平均升高.强化他汀组患者LDL-C、hs-CRP水平较常规他汀组明显下降(P＜0.05),APN、HDL-C水平明显升高.强化他汀组患者术中发生无复流现象3例,常规他汀组发生无复流现象6例,两组比较差异有统计学意义(P＜0.05).结论 强化他汀治疗能够降低择期PCI患者血浆炎性因子水平,升高血浆脂联素水平,减少PCI术中无复流的发生率,对择期PCI患者围手术期有很好的疗效和安全性.%Objectives To investigate the effect of intensive atorvastatin therapy in patients undergoing percutaneous coronary intervention( PCI). Whether it could attenuate the no/slow flow phenomenon and weather it could be associated with the upregulation of adiponectin (APN) and reduce inflammatory factors has never been investigated in the patients undergoing elective PCI. Methods All patients were randomly divided into intensive atorvastatin therapy ( group A) and moderate atorvastatin therapy (group B). The patients in group A were given atorvastatin 80mg/d for 2 days before PCI,followed by 40 mg/d for 30 days after PCI. The patients in group B were given atorvastatin 20 mg/d for 2 days before PCI,followed by 20 mg/d for 30 days after PCI. The 30 day incidence of major adverse cardiac events and the incidence of no/slow flow was recorded. Plasma levels of hs-CRP, HDL-C, LDL-C, APN and myocardial injury markers ( CK-MB and cTnI) were tested in the two groups before PCI and after one and three months. Results The main end point did not happened in the two groups after three month. No severe adverse effects were found in two groups. The plasma APN of patients were significantly increased and the hs-CRP were decreased in group A compared with group B after 1 month. The incidence of no/slow flow were 3/42 in group A and 6/42 in group B,There was significant difference between two groups. Conclusion Intensive statin therapy significantly decreases the incidence of no/slow flow in patients undergoing elective PCI,which is possibly associated with decreased hs-CRP and increased plasma adiponectin.