CAJ | 학술논문

目的：探讨经皮冠状动脉介入术（ PCI）术前大剂量阿托伐他汀再负荷治疗对长期他汀治疗的稳定性冠心病病人围术期循环内皮祖细胞（ EPCs）及炎症因子的影响。方法：将长期他汀治疗并择期PCI的稳定性心绞痛患者随机分为3组：术前12 h 80 mg阿托伐他汀负荷及术前2 h追加40 mg阿托伐他汀再负荷治疗（80 mg再负荷组）、连续7 d 40 mg阿托伐他汀再负荷治疗（40 mg再负荷组）和无阿托伐他汀再负荷治疗（无再负荷组）。应用流式细胞术分别测定所有患者PCI术前1 h、术后1 h、6 h及24 h外周血中标记为CD45－/CD133＋/CD34＋、CD45－/CD34＋/KDR＋和CD45－/CD144＋/KDR＋的EPCs数量；术前即刻及术后24 h分别测定血清可溶性细胞间黏附分子1（sICAM-1）、C反应蛋白（CRP）和肌钙蛋白（TnI）水平。结果：（1）80 mg再负荷组患者PCI术前与术后1 h外周血标记为CD45－/CD133＋/CD34＋和 CD45－/CD34＋/KDR＋的EPCs数量均有显著差异（P＜0.05），PCI术前与术后6 h外周血标记为上述两种指标的EPCs差异显著（ P＜0.05）；外周血标记为CD45－/CD144＋/KDR＋的EPCs在PCI术前和术后无显著变化；无再负荷组及40 mg再负荷组患者外周血EPCs在PCI术前和术后无显著变化。（2）PCI术后24 h无再负荷组sICAM-1及CRP水平较术前显著升高（P＜0.05）。 PCI术后24 h 80 mg再负荷组和40 mg再负荷组sICAM-1和CRP的升高幅度有减少趋势。（3）与无再负荷组相比，80 mg再负荷组PCI术后24 h血清TnI升高幅度显著降低（ P＜0.05）。结论： PCI术前阿托伐他汀再负荷方式影响围术期外周血EPCs数量。术前大剂量他汀短时间再负荷治疗提高围术期外周血中早期EPCs的数量。 PCI术前阿托伐他汀再负荷治疗减少围术期炎症反应及心肌损伤。
목적：탐토경피관상동맥개입술（ PCI）술전대제량아탁벌타정재부하치료대장기타정치료적은정성관심병병인위술기순배내피조세포（ EPCs）급염증인자적영향。방법：장장기타정치료병택기PCI적은정성심교통환자수궤분위3조：술전12 h 80 mg아탁벌타정부하급술전2 h추가40 mg아탁벌타정재부하치료（80 mg재부하조）、련속7 d 40 mg아탁벌타정재부하치료（40 mg재부하조）화무아탁벌타정재부하치료（무재부하조）。응용류식세포술분별측정소유환자PCI술전1 h、술후1 h、6 h급24 h외주혈중표기위CD45－/CD133＋/CD34＋、CD45－/CD34＋/KDR＋화CD45－/CD144＋/KDR＋적EPCs수량；술전즉각급술후24 h분별측정혈청가용성세포간점부분자1（sICAM-1）、C반응단백（CRP）화기개단백（TnI）수평。결과：（1）80 mg재부하조환자PCI술전여술후1 h외주혈표기위CD45－/CD133＋/CD34＋화 CD45－/CD34＋/KDR＋적EPCs수량균유현저차이（P＜0.05），PCI술전여술후6 h외주혈표기위상술량충지표적EPCs차이현저（ P＜0.05）；외주혈표기위CD45－/CD144＋/KDR＋적EPCs재PCI술전화술후무현저변화；무재부하조급40 mg재부하조환자외주혈EPCs재PCI술전화술후무현저변화。（2）PCI술후24 h무재부하조sICAM-1급CRP수평교술전현저승고（P＜0.05）。 PCI술후24 h 80 mg재부하조화40 mg재부하조sICAM-1화CRP적승고폭도유감소추세。（3）여무재부하조상비，80 mg재부하조PCI술후24 h혈청TnI승고폭도현저강저（ P＜0.05）。결론： PCI술전아탁벌타정재부하방식영향위술기외주혈EPCs수량。술전대제량타정단시간재부하치료제고위술기외주혈중조기EPCs적수량。 PCI술전아탁벌타정재부하치료감소위술기염증반응급심기손상。
AIM:To investigate the effects of atorvastatin reloading in pre-percutaneous coronary intervention ( PCI) period on endothelial progenitor cell ( EPC) count and inflammatory cytokine expression in the stable angina pectoris patients who had previously received long-term statin treatment.METHODS:The patients with stable angina pectoris that had received long-term statin therapy and planned to accept PCI were randomized into 3 groups:80 mg atorvastatin 12 h and 40 mg 2 h before coronary angioplasty (80 mg reloading), pre-operatively with 40 mg/d atorvastatin for 7 d (40 mg re-loading) , and without atorvastatin reloading ( no reloading ) .CD45 -/CD133+/CD34 +, CD45 -/CD34 +/KDR+ and CD45 -/CD144 +/KDR+EPCs in 100 μL peripheral blood were determined by flow cytometry 1 h prior to PCI and 1 h, 6 h and 24 h after PCI.The serum concentrations of soluble intercellular adhesion molecule 1 ( sICAM-1) , C-reactive protein ( CRP) and troponin I ( TnI) were analyzed immediately prior to and 24 h after PCI.RESULTS:(1) In 80 mg reloading group, the numbers of circulating CD45 -/CD133 +/CD34 +and CD45 -/CD34 +/KDR+early differentiation stage EPCs 1 h and 6 h after coronary angioplasty was significantly elevated compared with those before PCI (P<0.05).(2) In control group, the serum concentrations of sICAM-1 and CRP 24 h after PCI were significantly elevated ( P<0.05) compared with preoperative values.(3) The rise in serum TnI concentration from pre-to post-operation in 80 mg reloading group was lowerthan that in control group.CONCLUSION: The method of atorvastatin reload before PCI affects the number of EPCs inperi-operative period.High dose of atorvastatin application before PCI triggers early EPC circulation.The serum levels ofpost-operative inflammatory cytokine sICAM-1 as well as CRP are reduced by atorvastatin reloading before PCI.