不同负荷剂量阿托伐他汀钙对高龄冠心病患者经皮冠状动脉介入术后预后影响的对比研究

摘要

目的 比较不同负荷剂量阿托伐他汀钙对高龄冠心病患者经皮冠状动脉介入术(PCI)后预后的影响.方法 选取2011年5月-2014年10月西安医学院第二附属医院收治的高龄(≥80岁)冠心病患者150例,采用随机数字表法分为小剂量组、中剂量组和大剂量组,每组50例.3组患者分别于PCI前给予阿托伐他汀钙20 mg、40 mg、60 mg.比较3组患者冠状动脉病变及PCI情况,PCI前和PCI后12、24 h血清肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、超敏C反应蛋白(hs-CRP)水平,PCI后1个月主要心脏不良事件发生情况,阿托伐他汀钙治疗期间丙氨酸氨基转移酶(ALT)升高情况及他汀类药物相关肌病发生率.结果 (1)3组患者左主干病变、左前降支病变、左回旋支病变、右冠状动脉病变及3支病变发生率比较,差异均无统计学意义(P>0.05).3组患者支架置入数量、支架总长度、支架直径、支架展开时间、支架展开压力及使用药物洗脱支架者所占比例比较,差异均无统计学意义(P>0.05).(2)3组患者PCI前和PCI后12 h血清CK-MB、cTnI水平及PCI前血清hs-CRP水平比较,差异无统计学意义(P>0.05).PCI后12 h,中剂量组和大剂量组患者血清hs-CRP水平低于小剂量组,大剂量组患者血清hs-CRP水平低于中剂量组(P<0.05).PCI后24 h,中剂量组和大剂量组患者血清CK-MB、cTnI、hs-CRP水平低于小剂量组,大剂量组患者血清hs-CRP水平低于中剂量组(P<0.05).PCI后12、24 h 3组患者血清CK-MB、cTnI、hs-CRP水平均高于PCI前(P<0.05).(3)PCI后1个月,大剂量组患者主要心脏不良事件发生率低于小剂量组(P<0.05),而小剂量组和中剂量组、中剂量组和大剂量组患者主要心脏不良事件发生率比较,差异均无统计学意义(P>0.05).(4)3组患者ALT升高至80~120 U/L者所占比例和肌肉酸痛发生率比较,差异无统计学意义(P>0.05).结论 与中(40 mg)、小(20 mg)负荷剂量阿托伐他汀钙相比,PCI前给予大负荷剂量(60 mg)阿托伐他汀钙可更有效地减轻高龄(≥80岁)冠心病患者PCI后心肌损伤及炎性反应,降低患者主要心脏不良事件发生风险,且安全性较高.%Objective To compare the impact of different load-dose atorvastatin calcium on prognosis in coronary heart disease patients treated by PCI.Methods A total of 150 senile coronary heart disease patients(equal or over 80 years old)were selected in the Second Affiliated Hospital of Xi′an Medical College from May 2011 to October 2014,and they were divided into A group,B group and C group according to random number table,each of 50 cases.Before PCI,patients of A group received small load-dose atorvastatin calcium(20 mg),patients of B group received middle load-dose atorvastatin calcium(40 mg),while patients of C group received high load-dose atorvastatin calcium(60 mg).Coronary artery lesions,PCI related index,serum levels of CK-MB, cTnI and hs-CRP before PCI,after 12 and 24 hours of PCI,incidence of main adverse cardiac events after 1 month of PCI,incidence of ALT elevation and statins associated myopathy during the treatment of atorvastatin calcium.Results (1)No statistically significant differences of incidence of left main coronary artery lesion,left anterior descending branch lesion,left circumflex branch lesion,right coronary artery lesion or triple-vessel lesion was found among the three groups,nor was number of implanted stents,total length of implanted stents,diameter of implanted stents,stents expanding time,expanding pressure or proportion of patients received drug eluting stents was found among the three groups.(2)No statistically significant differences of serum level of CK-MB,cTnI or hs-CRP was found among the three groups before PCI,nor was serum level of CK-MB or cTnI after 12 hours of PCI(P>0.05);after 12 hours of PCI,serum hs-CRP level of B group and C group was statistically significantly lower than that of A group,respectively,meanwhile serum hs-CRP level of C group was statistically significantly lower than that of B group(P<0.05).After 24 hours of PCI,serum levels of CK-MB,cTnI and hs-CRP of B group and C group were statistically significantly lower than those of A group,meanwhile serum hs-CRP level of C group was statistically significantly lower than that of B group(P<0.05).After 12 and 24 hours of PCI,serum levels of CK-MB,cTnI and hs-CRP of the three group were statistically statistically significantly higher than those before PCI.(3)After 1 month of PCI,incidence of main adverse cardiac events of C group was statistically significantly lower than that of A group(P<0.05),while no statistically significant differences of incidence of main adverse cardiac events was found between A group and B group,nor was between B group and C group(P>0.05).(4)No statistically significant differences of proportion of patients with ALT elevated to 80-120 U/L or incidence of muscular soreness was found among the three groups(P>0.05).Conclusion Compared with small load-dose atorvastatin calcium(20 mg)and middle load-dose atorvastatin calcium(40 mg),high load-dose atorvastatin calcium(60 mg) can more effectively relive the postoperative myocardial damage and inflammatory reaction of senile coronary heart disease patients(equal or over 80 years old)treated by PCI,reduce the risk of main adverse cardiac events,with relatively high safety.