CAJ | 학술논문

目的：：探讨老年非ST段抬高急性冠状动脉综合征( NSTEACS)患者PCI术前负荷剂量瑞舒伐他汀治疗对血清凝集素样氧化低密度脂蛋白受体-1(Lox-1)高敏C反应蛋白(hs-CRP)及近期预后的影响。方法：将72例老年NSTEACS患者随机分为负荷治疗组33例和对照组39例,负荷治疗组PCI术前12 h顿服瑞舒伐他汀20 mg,PCI术前2 h追加瑞舒伐他汀20 mg。所有患者于术前、术后24 h、术后30 d抽取静脉血,检测Lox-1、hs-CRP、肌酸激酶同工酶( CK-MB)、心肌肌钙蛋白Ⅰ( cTnⅠ)等。随访30 d观察主要不良心脏事件发生率。结果：与术前比较,2组患者PCI术后24 h血清Lox-1、hs-CRP均明显升高( P<0.05),心肌损伤标志物CK-MB、cTnⅠ亦明显升高( P<0.01)；但负荷治疗组Lox-1、hs-CRP、CK-MB、cTnⅠ升高幅度均显著低于对照组( P<0.05)。术后30 d负荷治疗组血清Lox-1、hs-CRP仍显著低于对照组( P<0.05)。与术前比较,术后24 h 2组患者血清总胆固醇( TC )及低密度脂蛋白胆固醇( LDL-C )水平均未见明显变化( P >0.05),术后30 d出现显著下降(P<0.05),但两组之间比较差异无统计学意义。与术前比较,2组患者PCI术后24 h、30 d血清ALT及Scr水平均未见明显升高。负荷治疗组主要不良心脏事件总发生率较对照组低(9.09% vs 28.21%,P<0.05)。结论：老年NSTEACS患者PCI术前负荷剂量瑞舒伐他汀能明显降低PCI术后Lox-1水平,减轻患者的心肌损伤及炎症反应,降低PCI术后近期不良心脏事件的发生率,其独立于他汀类药物调脂作用以外,且应用安全。
목적：：탐토노년비ST단태고급성관상동맥종합정( NSTEACS)환자PCI술전부하제량서서벌타정치료대혈청응집소양양화저밀도지단백수체-1(Lox-1)고민C반응단백(hs-CRP)급근기예후적영향。방법：장72례노년NSTEACS환자수궤분위부하치료조33례화대조조39례,부하치료조PCI술전12 h돈복서서벌타정20 mg,PCI술전2 h추가서서벌타정20 mg。소유환자우술전、술후24 h、술후30 d추취정맥혈,검측Lox-1、hs-CRP、기산격매동공매( CK-MB)、심기기개단백Ⅰ( cTnⅠ)등。수방30 d관찰주요불양심장사건발생솔。결과：여술전비교,2조환자PCI술후24 h혈청Lox-1、hs-CRP균명현승고( P<0.05),심기손상표지물CK-MB、cTnⅠ역명현승고( P<0.01)；단부하치료조Lox-1、hs-CRP、CK-MB、cTnⅠ승고폭도균현저저우대조조( P<0.05)。술후30 d부하치료조혈청Lox-1、hs-CRP잉현저저우대조조( P<0.05)。여술전비교,술후24 h 2조환자혈청총담고순( TC )급저밀도지단백담고순( LDL-C )수평균미견명현변화( P >0.05),술후30 d출현현저하강(P<0.05),단량조지간비교차이무통계학의의。여술전비교,2조환자PCI술후24 h、30 d혈청ALT급Scr수평균미견명현승고。부하치료조주요불양심장사건총발생솔교대조조저(9.09% vs 28.21%,P<0.05)。결론：노년NSTEACS환자PCI술전부하제량서서벌타정능명현강저PCI술후Lox-1수평,감경환자적심기손상급염증반응,강저PCI술후근기불양심장사건적발생솔,기독립우타정류약물조지작용이외,차응용안전。
Objective:To investigate the effect of loading-dose rosuvastatin on serum levels of lectin-like oxidized low-density lipoprotein receptor-1(Lox-1)and high-sensitivity c-reactive protein (hs-CRP) and recent prognosis in old patients with non-ST segment elevation acute coronary syndrome( NSTEACS) undergoing selected percutaneous coronary intervention. Methods:A total of 72 patients with non-ST segment elevation ACS were randomly divided into loading-dose group pretreated with rosuvastatin 20 mg 12 h before PCI and with a further 20 mg preprocedure dose(n=33) and control group treated with standard dose(n=39). Serum levels of Lox-1, hs-CRP, CK-MB and cTnⅠ were measured before and 24 h,30 d after the PCI. The 30-day incidence of major adverse cardiac events was recorded in both groups. Results:Compared with before PCI, serum levels of Lox-1 and hs-CRP of the two groups were elevated at 24 h after PCI ( P<0 . 05 ) , the levels of CK-MB and cTnⅠ were also increased ( P <0. 01), however, the values of Lox-1,hs-CRP,CK-MB and cTnⅠwere significantly lower in loading-dose group than those in control group. Serum levels of Lox-1 and hs-CRP were lower in loading-dose group than those in control group at 30 d after PCI (P<0. 05). The levels of TC and LDL-C were not changed at 24 h after PCI (P>0. 05) until 30 d after PCI (P<0. 05), but there was no singnificantly difference between the two groups. The levels of ALT and Scr were not elevated in two groups before and after PCI. The 30-day incidence of MACE occurred in 9. 09% of patients in loading-dose group and in 28. 21% of the control group(P <0. 05). Conclusion: The loading-dose rosuvastatin for old patients with non- ST segment elevation acute coronary syndromes undergoing selected percutaneous coronary intervention can attenuate the increase of serum levels of Lox-1, and reduce myocardial injury and inflammatory reaction caused by PCI, also reduce the occurrence of MACE in 30 d after PCI.