不同负荷剂量他汀类药物对老年急性心肌梗死直接介入治疗术后心肌细胞的影响被引量：25

Effect of different statin doses on myocardial cells in elderly acute myocardial infarction patients after primary PCI

暂未订购

导出

摘要目的比较不同负荷剂量他汀类药物对老年急性ST段抬高型心肌梗死(STEMI)直接PCI术后心肌的影响。方法老年STEMI行直接PCI患者120例,随机分4组,每组30例,阿托伐负荷组(80mg),阿托伐常规组(20mg),瑞舒伐负荷组(20mg),瑞舒伐常规组(5mg),分别检测PCI术前和术后2h炎性、氧化活性和纤溶活性指标。比较术后ST段回落指数(STR)、校正TIMI帧计数(CTFC)、30d心脏彩色超声和主要心脏不良事件(MACE)。结果阿托伐负荷组与阿托伐常规组、瑞舒伐负荷组与瑞舒伐常规组术后2h炎性、氧化活性和纤溶活性指标比较有显著差异(P<0.05)。阿托伐负荷组与阿托伐常规组、瑞舒伐负荷组与瑞舒伐常规组CTFC[(15.2±4.6)帧vs(21.7±5.2)帧,(15.6±4.2)帧vs(22.9±5.9)帧]和STR≥50%(93.3%vs 46.7%,86.7%vs43.3%)比较有显著差异(P<0.05)。2个负荷组30dLVEF和MACE均好于2个常规组(P<0.05),2个负荷组上述各项比较无显著差异(P>0.05)。结论老年STEMI行直接PCI术前用负荷剂量他汀类药物,可降低氧化应激,减少心肌细胞坏死,改善短期预后,阿托伐他汀与瑞舒伐他汀无显著差异。 Objective To compare the effect of different statin doses on myocardial cells in elderly STEMI patients after primary PCI.Methods One hundred and twenty elderly STEMI patients undergoing primary PCI were randomly divided into atorvastatin loading dose group,routine atorvastatin dose group,rosuvastatin loading dose group,and routine rosuvastatin dose group（30in each group）.Their serum levels of hs-CRP,SAA,ALT,BNP,cTnI,ET,NO,t-PA,PAI,MDA and SOD were measured before and 2hafter PCI.Their STR,CTFC,30-day LVEF and MACE were compared after PCI.Results The serum levels of hs-CRP,SAA,cTnI,NO,t-PA were significantly higher in 4groups 2hafter PCI（P〈0.05）.However,the serum levels of hs-CRP,SAA,BNP,cTnI,ET-1,PAI-1,SOD were significantly lower and those of No,t-PA,MDA were significantly higher in atorvastatin and rosuvastatin loading dose groups than in routine atorvastatin and rosuvastatin dose groups 2hafter PCI（P〈0.05）.No significant difference was found in these parameters between the two loading dose groups（P〈0.05）.Conculsion Statin loading dose can reduce the oxidative stress,necrosis of myocardial cells and improve the short-term outcome in elderly STEMI patients before primary PCI.The efect of atorvastatin and rosuvastatin on myocardial cells is similar in elderly AMI patients after primary PCI.

作者葛广豪龚勇马江伟杨栓锁刘化进熊三军侯月梅乔增勇方唯一

机构地区苏州大学医学部上海交通大学附属第六人民医院南院心内科上海交通大学附属胸科医院心内科

出处《中华老年心脑血管病杂志》 CAS 2016年第9期899-904,共6页 Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基金上海市卫生局青年科研项目(20134y116)

关键词心肌梗死微循环肌钙蛋白Ⅰ 组织型纤溶酶原激活物丙二醛降血脂药 myocardial infarction microcirculation troponin I tissue plasminogen activator malondialdehyde antilipemic agents

分类号 R542.22 [医药卫生—心血管疾病]

引文网络
相关文献

参考文献15

1霍勇,葛均波,韩雅玲,王建安,万征,李建平,钱菊英,王斌,项美香,孙跃民,代表<急性冠状动脉综合征患者强化他汀治疗专家共识>专家组.急性冠状动脉综合征患者强化他汀治疗专家共识[J].中国介入心脏病学杂志,2014,22(1):4-6. 被引量：94
2王澈,齐大屯.介入治疗对急性冠脉综合征患者血小板活化及炎症因子的影响[J].中国老年学杂志,2012,32(22):5022-5023. 被引量：10
3Plakht Y,Gilutz H,Shiyovich A.Ethnical disparities in temporal trends of acute myocardial infarction(AMI)throughout a decade in Israel.Soroka acute myocardial infarction(SAMI-Ⅱ)project.Int J Cardiol,2016,214:469-476.
4Unni SK,Quek RG,Biskupiak J,et al.Assessment of statin therapy,LDL-C levels,and cardiovascular events among highrisk patients in the United States.J Clin Lipidol,2016,10:63-71.
5Di Sciascio G,Patti G,Pascein V,et al.Efficacy of atorvastatin reload in patients on chronic statin therapy undergoing percutaneous coronary intervention:results of the ARMYDARECAP TURE(Atorvasatin for Reduction of Myocardial Damage during Angioplasty)randomized trial.J Am Coll Cardiol,2009,54:558-565.
6Patti G,PascerìV,Colonna G,et al.Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention:results of the ARMYDA-ACS randomized trial.J Am Coll Cardiol,2007,49:1272-1278.
7Yun KH,Oh SK,Rbee SJ,et al.12-month follow-up results of high dose rosuvastatin loading before percutaneous coronary intervention in patient with acute coronary syndrome.Int J Cardiol,2011,146:68-72.
8Stone NJ,Robinson JG,Lichtenstein AH,et al.2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.J Am Coll Cardiol,2014,63:2889-2934.
9Kim JS,Kim J,Choi D,et al.Efficacy of high-dose atorvastatin loading before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction:the STAIN STEMI trial.JACC Cardiovasc Interv,2010,3:332-339.
10戴敬,吕树铮,宋现涛,张闽,张东风,张明多,王蔚,玉献鹏,李伟.围术期阿托伐他汀序贯治疗对急性ST段抬高性心肌梗死患者组织灌注和临床预后的探讨[J].心肺血管病杂志,2015,34(1):7-11. 被引量：24

二级参考文献26

1孙静,胡小怀,李上海.急性冠脉综合征患者血浆hs-CRP、BNP、SAA的含量变化及其临床意义[J].中国实用医药,2007,2(36):48-50. 被引量：7
2苏钦峰,赵玉兰.2型糖尿病患者纤溶系统的变化与大血管病变的相关性研究[J].医药论坛杂志,2007,28(11):34-36. 被引量：6
3贺立群,冯义柏,马长生,聂绍平,吕树铮,顾承雄,吴学思.他汀类药物对冠状动脉血运重建患者院内不良事件的影响[J].山东医药,2007,47(7):9-10. 被引量：2
4Burazeri G,Goda A,Sulo G,et al.Conventional risk factors and acute coronary syndrome during a period of socioeconomic transition:popula-tion-based case-control study in Tirana,Albania[J].Croat Med J,2007;48(2):225-33.
5James SK,Lindahl B,Siegbahn A,et al.N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease:a global utilization of strategies to open occluded arteries(GUS-TO)-Ⅳsubstudy[J].Circulation,2003;108(3):275-81.
6Braunwald E,Antman EM,Beasley JW,et al.ACC/AHA guidelines for the management of patients with unstable angina and non-st-segment ele-vation myocardial infarction.A report of the American Collage of Cardiol-ogy/American Heart Association Task Force or Practice Guidelines[J].J Am Coll Cardiol,2000;36(3):970-1062.
7Ridker PM,Rifai N,Rose L,et al.Comparison of C-reactive protein and low-density lipoprotein cholesterol levels in the prediction of first cardio-vascular events[J].N Engl J Med,2002;347(20):1557-65.
8Boos CJ,Lip GY.Platelet activation and cardiovascular outcomes in acute coronary syndromes[J].J Thromb Haemost,2006;4(12):2542-3.
9Azici M,Demircan S,Durna K,et al.Relationship between myocardial in-jury and soluble P-selectin in non-ST elevation acute coronary syndromes[J].Circ J,2005;69(5):530-5.
10Ziakas A,Gavrilidis S,Giannoglou G,el al.In-hospital and long-term prognostic value of fibrinogen,CRP,and IL-6 levels in patients with a-cute myocardial infarction treated with thrombolysis[J].Angiology,2006;57(3):283-93.