不同剂量国产瑞舒伐他汀对经皮冠状动脉介入治疗后不稳定型心绞痛患者心肌保护作用及其安全性的比较研究

摘要

目的：比较不同剂量国产瑞舒伐他汀对经皮冠状动脉介入（PCI）治疗后不稳定型心绞痛患者的心肌保护作用及其安全性。方法选取2013年10月—2014年10月聊城市第二人民医院心内科收治的拟行 PCI 治疗的不稳定型心绞痛患者80例，随机分为观察组和对照组，每组40例。两组患者均行择期 PCI 治疗，对照组患者术前给予常规剂量国产瑞舒伐他汀（10 mg/ d），观察组患者术前给予大剂量国产瑞舒伐他汀（20 mg/ d），疗程均为3~7 d。比较两组患者术前和术后24 h 心肌损伤标志物〔心肌肌钙蛋白 T（cTnT）、肌酸激酶同工酶（CK-MB）〕水平、超敏 C 反应蛋白（hs-CRP）水平以及观察组患者术前和术后24 h 丙氨酸氨基转移酶（ALT）、血肌酐（Scr）、尿素氮（BUN）水平，观察两组患者术后30 d 心脏不良事件（如再次血运重建、心肌梗死或死亡）发生情况。结果两组患者术前cTnT、CK-MB、hs-CRP水平比较，差异无统计学意义（P ﹥0.05）；观察组患者术后24 h cTnT、CK-MB、hs-CRP水平低于对照组（P ﹤0.05）；术后24 h 两组患者 cTnT、CK-MB水平均高于术前，hs-CRP水平低于术前（P ﹤0.05）。观察组患者术前及术后24 h ALT、Scr、BUN 水平比较，差异无统计学意义（ P ﹥0.05）。两组无一例患者停用、减用或换用其他他汀类药物。观察组患者术后30 d 心脏不良事件发生率低于对照组（P ﹤0.05）。结论大剂量国产瑞舒伐他汀较常规剂量国产瑞舒伐他汀对 PCI 治疗后不稳定型心绞痛患者的心肌保护作用更明显，且安全性较高，能有效减少心脏不良事件的发生。%Objective To compare the cardioprotective effects in postoperative patients with unstable angina pectoris treated by PCI between standard - dose and large - dose domestic rosuvastatin. Methods A total of 80 patients with unstable angina pectoris were selected in the Second People's Hospital of Liaocheng from October 2013 to October 2014,and they were randomly divided into control group and observation group,each of 40 cases. All of the patients received delayed PCI,and patients of control group received standard - dose domestic rosuvastatin(10 mg/ d) before PCI,while patients of observation group received large - dose domestic rosuvastatin(20 mg/ d)before PCI;both groups treated for 3 to 7 days. Before PCI and after 24 hours of PCI,cTnT,CK-MB and hs-CRP levels were compared between the two groups,ALT,Scr and BUN levels of observation group were compared before PCI and after 24 hours of PCI,and incidence of major adverse cardiovascular events (including repeat revascularization,myocardial infarction and death) after 30 days of PCI of the two groups was observed. Results No statistically significant differences of cTnT,CK-MB or hs-CRP levels was found between the two groups before PCI (P ﹥ 0. 05),while cTnT,CK-MB and hs-CRP levels of observation group were statistically significantly lower than those of control group after 24 hours of PCI(P ﹤ 0. 05);cTnT and CK-MB levels of the two groups after 24 hours of PCI were statistically significantly higher than those before PCI,while hs-CRP levels of the two groups after 24 hours of PCI were statistically significantly lower than those before PCI( P ﹤ 0. 05). No statistically significant differences of ALT,Scr or BUN levels of observation group was found before PCI and after 24 hours of PCI(P ﹥ 0. 05). No one of the two groups stopped,reduced or changed rosuvastatin. The incidence of major adverse cardiovascular events after 30 days of PCI of observation group was statistically significantly lower than that of control group(P ﹤ 0. 05). Conclusion Large - dose domestic rosuvastatin has better cardioprotective effects in postoperative patients with unstable angina pectoris treated by PCI than standard - dose domestic rosuvastatin,is relatively safe,and can more effectively reduce the incidence of major adverse cardiovascular events.