CAJ | 학술논문

目的：探讨术前使用不同剂量瑞舒伐他汀对择期行经皮冠状动脉介入治疗（PCI）的冠状动脉粥样硬化性心脏病（CHD）患者的心肌保护作用。方法选择2012年10月至2014年2月收治的173例择期行PCI治疗的CHD患者根据术前使用瑞舒片他汀剂量不同分为A组（瑞舒伐他汀10 mg，58例）、B 组（瑞舒伐他汀20 mg，59例）和C组（瑞舒伐他汀40 mg，56例），三组患者均在治疗前抽血测定肝肾功能、血脂指标，并观察其球囊扩张次数和置入支架情况。于术前、术后24 h、术后7 d测定各组患者血清超敏C反应蛋白（hs-CRP），白介素-18（IL-18），肌酸激酶同工酶（CK-MB），肌钙蛋白T（cTn-T）水平。采用全自动生化分析仪测定肝肾功能、血脂及CK-MB、cTn-T等指标，采用酶联免疫吸附试验法测定IL-8水平，免疫浊度法测定hs-CRP水平。结果三组患者治疗前肝肾功能、血脂指标及球囊扩张次数、置入支架数比较，差异均无统计学意义（P＞0.05）。三组患者PCI术前hs-CRP、IL-18、CK-MB、cTn-T水平比较，差异均无统计学意义（P＞0.05）；三组患者PCI术后24 h hs-CRP、IL-18、CK-MB、cTn-I水平较同组术前均增高，而术后7 d hs-CRP、IL-18、CK-MB、cTn-T水平较同组术前、术后24 h均降低，差异均有统计学意义（P<0.05）；三组患者间术后7 d各指标水平比较，C组明显优于A、B组，差异均有统计学意义（P<0.05）。三组患者术后心血管事件和不良反应发生率[8.62%（5/58）、5.08%（3/59）、7.14%（4/56）]比较，差异均无统计学意义（P＞0.05）。结论择期PCI术术前应用20、40 mg瑞舒伐他汀对PCI术后心肌损伤保护作用均优于10 mg，且40 mg作用效果优于20 mg，安全性良好。
목적：탐토술전사용불동제량서서벌타정대택기행경피관상동맥개입치료（PCI）적관상동맥죽양경화성심장병（CHD）환자적심기보호작용。방법선택2012년10월지2014년2월수치적173례택기행PCI치료적CHD환자근거술전사용서서편타정제량불동분위A조（서서벌타정10 mg，58례）、B 조（서서벌타정20 mg，59례）화C조（서서벌타정40 mg，56례），삼조환자균재치료전추혈측정간신공능、혈지지표，병관찰기구낭확장차수화치입지가정황。우술전、술후24 h、술후7 d측정각조환자혈청초민C반응단백（hs-CRP），백개소-18（IL-18），기산격매동공매（CK-MB），기개단백T（cTn-T）수평。채용전자동생화분석의측정간신공능、혈지급CK-MB、cTn-T등지표，채용매련면역흡부시험법측정IL-8수평，면역탁도법측정hs-CRP수평。결과삼조환자치료전간신공능、혈지지표급구낭확장차수、치입지가수비교，차이균무통계학의의（P＞0.05）。삼조환자PCI술전hs-CRP、IL-18、CK-MB、cTn-T수평비교，차이균무통계학의의（P＞0.05）；삼조환자PCI술후24 h hs-CRP、IL-18、CK-MB、cTn-I수평교동조술전균증고，이술후7 d hs-CRP、IL-18、CK-MB、cTn-T수평교동조술전、술후24 h균강저，차이균유통계학의의（P<0.05）；삼조환자간술후7 d각지표수평비교，C조명현우우A、B조，차이균유통계학의의（P<0.05）。삼조환자술후심혈관사건화불량반응발생솔[8.62%（5/58）、5.08%（3/59）、7.14%（4/56）]비교，차이균무통계학의의（P＞0.05）。결론택기PCI술술전응용20、40 mg서서벌타정대PCI술후심기손상보호작용균우우10 mg，차40 mg작용효과우우20 mg，안전성량호。
Objective To approach the protective effects of different-dose rosuvastatin at the perioperative period on percutaneous coronary intervention (PCI) on patients with coronary heart disease (CHD). Methods A total of 173 patients with PCI from Octoer 2012 to February 2014 were selected and divided into group A (10 mg rosuvastatin,n=58),group B(20 mg rosu-vastatin,n=59),and group C(40 mg rosuvastatin,n=56) according to the doses of rosuvastatin. The three groups were examined in liver and renal functions,serum lipid parameters as well as times of balloon dilatation and quantity of bailout-stenting. The level of high-sensitive c-reactive protein (hs-CRP),interleukin-18 (IL-18),creatine kinase isoenzyme (CK-MB)and troponin-T (cTn-T) were determined before the operation ,after postoperative 24 h and 7 d respectively. Automatic biochemical analyzer was used to detected to the parameters of liver and renal functions,blood fat,CK-MB and cTn-T as well as IL-8 by enzyme-linked immunosor-bent assay and hs-CRP by immunoturbidimetry. Results The liver and renal function,serum lipid parameters as well as times of balloon dilatation and quantity of bailout-stenting before the treatment among the three groups were compared ,whose difference has no statistic significance(P>0.05). The level of hs-CRP、IL-18、CK-MB、cTn-T before operation compared and showed no statistic significance in difference(P>0.05);The levels of hs-CRP、IL-18、CK-MB、cTn-I after postoperative 24 h were higher than those before operation;The levels of hs-CRP、IL-18、CK-MB、cTn-I after postoperative 7 d were higher than those before operation and after postoperative 24 h (P<0.05);Comparing these parameters after postoperative 7 d among the three groups ,group C is super visor than those of group B(P<0.05). The cardiovascular events and incidences of adverse effects after the operation among the three groups were compared[8.62%(5/58),5.08%(3/59),7.14%(4/56)],which was no difference in statistic significance (P>0.05). Conclusion The rosuvastatin with doses at 20 mg,40 mg against myocardial injury at the preoperative period with PCI after op-eration is better in than the dose at 10 mg,further,the effect of 40 mg-dose is supervisor than the dose at 20 mg.