CAJ | 학술논문

目的：观察阿托伐他汀钙预治疗对急性冠脉综合征（ACS）经皮冠状动脉介入术（PCI）后血流灌注及预后的影响。方法入选2012年4月至2014年6月在郑州人民医院心内科住院的ACS患者100例，拟行PCI术，包括急性ST段抬高型心肌梗死、急性非ST段抬高型心肌梗死和不稳定型心绞痛。在术前连续口服阿托伐他汀钙片3个月以上的患者作为干预组（50例）。另外随机选取因ACS首次行PCI治疗，术前未应用他汀类药物的患者作为对照组（50例）。监测两组患者PCI术前、术后12 h、24 h炎性反应和心肌损伤标记物的变化，术后20 min靶血管前向血流的TIMI血流分级情况，随访两组患者PCI术后1个月内心血管事件。结果干预组患者的血清总胆固醇[（4.2±1.5）mmol/L vs.（7.0±1.8）mmol/L]、三酰甘油[（1.2±0.7） mmol/L vs.（1.9±0.8）mmol/L]水平显著低于对照组，差异具有显著统计学意义（P均＜0.01）。PCI术前、术后12 h及24 h，干预组患者的心肌肌钙蛋白、肌酸激酶同工酶、白细胞介素-6、超敏C反应蛋白均低于对照组（P＜0.05或P＜0.01）。PCI术前及术后，干预组患者的TIMI及TMPG血流分级均优于对照组（P＜0.05或P＜0.01）。干预组患者的术中无复流现象的发生率（6% vs.20%）低于对照组，差异具有统计学意义（P＜0.05）。PCI术后1个月内，干预组心血管事件发生率显著低于对照组（P＜0.05）。结论阿托伐他汀钙预治疗可以改善PCI术后血流灌注，降低炎性反应，减轻心肌损伤，减少近期心血管事件的发生，改善ACS患者预后。
목적：관찰아탁벌타정개예치료대급성관맥종합정（ACS）경피관상동맥개입술（PCI）후혈류관주급예후적영향。방법입선2012년4월지2014년6월재정주인민의원심내과주원적ACS환자100례，의행PCI술，포괄급성ST단태고형심기경사、급성비ST단태고형심기경사화불은정형심교통。재술전련속구복아탁벌타정개편3개월이상적환자작위간예조（50례）。령외수궤선취인ACS수차행PCI치료，술전미응용타정류약물적환자작위대조조（50례）。감측량조환자PCI술전、술후12 h、24 h염성반응화심기손상표기물적변화，술후20 min파혈관전향혈류적TIMI혈류분급정황，수방량조환자PCI술후1개월내심혈관사건。결과간예조환자적혈청총담고순[（4.2±1.5）mmol/L vs.（7.0±1.8）mmol/L]、삼선감유[（1.2±0.7） mmol/L vs.（1.9±0.8）mmol/L]수평현저저우대조조，차이구유현저통계학의의（P균＜0.01）。PCI술전、술후12 h급24 h，간예조환자적심기기개단백、기산격매동공매、백세포개소-6、초민C반응단백균저우대조조（P＜0.05혹P＜0.01）。PCI술전급술후，간예조환자적TIMI급TMPG혈류분급균우우대조조（P＜0.05혹P＜0.01）。간예조환자적술중무복류현상적발생솔（6% vs.20%）저우대조조，차이구유통계학의의（P＜0.05）。PCI술후1개월내，간예조심혈관사건발생솔현저저우대조조（P＜0.05）。결론아탁벌타정개예치료가이개선PCI술후혈류관주，강저염성반응，감경심기손상，감소근기심혈관사건적발생，개선ACS환자예후。
Objective To observe the influences of atorvastatin calcium pre-treatment on blood perfusion and prognosis in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI). Methods ACS patients [n=100, including those with ST-segment elevation myocardial infarction (STEMI), acute non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina pectoris (UAP)] were chosen from Apr. 2012 to June 2014. The patients given atorvastatin calcium for 3 m before PCI were set as convention group (n=50), and other patients who would be given PCI due to ACS without statins pre-treatment were set as control group (n=50). The inflammatory reaction and changes of myocardial injury markers were monitored at different time points (before and 12 h and 24 h after PCI). TIMI flow grading of target vessel antegrade flow 20 min after PCI was observed. The incidence of major adverse cardiovascular events (MACE) was followed up after PCI for 1 m. Results The levels of serum total cholesterol [(4.2±1.5) mmol/L vs. (7.0±1.8) mmol/L] and triglyceride [(1.2±0.7) mmol/L vs. (1.9±0.8) mmol/L] were significantly lower in intervention group than those in control group (all P<0.01). The levels of cTnT, CK-MB, IL-6 and hs-CRP were lower in intervention group than those in control group (P<0.05 or P<0.01) before and 12 h and 24 h after PCI. TIMI flow grading and TMPG flow grading were better in intervention group than those in control group (P<0.05 or P<0.01). The incidence of non-reflow during PCI was lower in intervention group than that in control group (6%vs. 20%, P<0.05). The incidence of MACE was significantly lower in intervention group than that in control group (P<0.05) 1 m after PCI. Conclusion Atorvastatin calcium pre-treatment can improve blood perfusion, ameliorate inflammatory reaction, relieve myocardial injury, reduce short-term incidence of MACE and improve prognosis in ACS patients.