CAJ | 학술논문

目的：探讨急诊经皮冠状动脉介入术（PCI）术前阿托伐他汀强化治疗对ST段抬高心肌梗死（STEMI）患者术后ST段回落、血清炎症因子及内皮功能的影响。方法纳入2010年3月~2010年12月武警总医院发病时间＜12 h、拟行急诊PCI的STEMI患者95例，按照随机信封法随机分为3组：A组（n=34，术前给予负荷剂量阿托伐他汀80 mg，术后给予阿托伐他汀40 mg/d）；B组（n=34，术前不服用他汀类药物，术后给予阿托伐他汀40 mg/d）；C组（n=30，术前不服用他汀类药物，术后给予常规剂量阿托伐他汀20 mg/d），观察术后90 min内ST段回落情况以及术后24 h、3 d、7 d高敏C反应蛋白（hs-CRP）及NO合酶（NOS）的变化情况。结果术后90 min内A组ST段回落比例更高，同时回落幅度也更大，与B组和C组均有统计学差异（P＜0.05）；术后24 h，A组高敏C反应蛋白（hs-CRP）水平下降，但与B组和C组无统计学差异；术后3 d和7 d，A组hs-CRP进一步下降，且与B组和C组达到统计学差异（P＜0.05）；术后24 h及术后3 d，A组一氧化氮合成酶（NOS）水平高于B组和C组，但与B组和C组比较无统计学差异（P＞0.05）；术后7 d，A组NOS水平继续升高，与B组和C组达到统计学差异（P＜0.05）。结论急诊PCI术前一次性给予大剂量（80 mg）阿托伐他汀强化治疗有利于STEMI患者心肌灌注恢复，并能够降低炎症反应，改善血管内皮功能。
목적：탐토급진경피관상동맥개입술（PCI）술전아탁벌타정강화치료대ST단태고심기경사（STEMI）환자술후ST단회락、혈청염증인자급내피공능적영향。방법납입2010년3월~2010년12월무경총의원발병시간＜12 h、의행급진PCI적STEMI환자95례，안조수궤신봉법수궤분위3조：A조（n=34，술전급여부하제량아탁벌타정80 mg，술후급여아탁벌타정40 mg/d）；B조（n=34，술전불복용타정류약물，술후급여아탁벌타정40 mg/d）；C조（n=30，술전불복용타정류약물，술후급여상규제량아탁벌타정20 mg/d），관찰술후90 min내ST단회락정황이급술후24 h、3 d、7 d고민C반응단백（hs-CRP）급NO합매（NOS）적변화정황。결과술후90 min내A조ST단회락비례경고，동시회락폭도야경대，여B조화C조균유통계학차이（P＜0.05）；술후24 h，A조고민C반응단백（hs-CRP）수평하강，단여B조화C조무통계학차이；술후3 d화7 d，A조hs-CRP진일보하강，차여B조화C조체도통계학차이（P＜0.05）；술후24 h급술후3 d，A조일양화담합성매（NOS）수평고우B조화C조，단여B조화C조비교무통계학차이（P＞0.05）；술후7 d，A조NOS수평계속승고，여B조화C조체도통계학차이（P＜0.05）。결론급진PCI술전일차성급여대제량（80 mg）아탁벌타정강화치료유리우STEMI환자심기관주회복，병능구강저염증반응，개선혈관내피공능。
Objective To investigate the influences of pre-operation intensive treatment of atorvastatin (80 mg) on post-operation ST-segment resolution index (STRI), serum inflammatory factors and endothelial function in the patients with ST-segment elevation myocardial infarction (STEMI). Methods The STEMI patients (n=95, onset<12 h) who planed accepting emergency PCI were chosen from the General Hospital of Chinese People’ s Armed Police Forces from Mar. 2010 to Dec. 2010, and randomly divide into group A (n=34, 80 mg atorvastatin before PCI and 40 mg/d after PCI), group B (n=34, no atorvastatin before PCI and 40 mg/d after PCI) and group C (n=30, no atorvastatin before PCI and 20 mg/d after PCI). The changes of STRI within 90 min after PCI, and high sensitivity C-reactive protein (hs-CRP) and NO synthase (NOS) after PCI for 24 h, 3 d and 7 d were observed. Results Within 90 min after PCI, the percentage and extent of ST-segment resolution were higher in group A compared with those in group B and group C (P<0.05). After PCI for 24 h, the level of hs-CRP decreased in group A, which had no statistical difference compared with group B and group C. After PCI for 3 d and 7 d, the level of hs-CRP decreased further in group A, which had statistical difference compared with group B and group C (P<0.05). After PCI for 24 h and 3 d, the level of NOS was higher in group A than that in group B and group C, which had no statistical difference (P>0.05). After PCI for 7 d, the level of NOS increased continuously in group A, which had statistical difference compared with group B and group C (P<0.05). Conclusion The one-time administration of high-dose atorvastatin (80 mg) before emergency PCI is benefit to alleviate the myocardial perfusion and inflammatory reactions, and improve vascular endothelial function in STEMI patients.