中国医师杂志
中國醫師雜誌
중국의사잡지
JOURNAL OF CHINESE PHYSICIAN
2015年
4期
519-523
,共5页
李韶南%刘震%黄慧芳%陈平安%雷晓明
李韶南%劉震%黃慧芳%陳平安%雷曉明
리소남%류진%황혜방%진평안%뢰효명
庚酸类/投药和剂量%吡咯类/投药和剂量%心肌梗死/病理生理学/药物疗法%血小板/药物作用%心室重构/药物作用
庚痠類/投藥和劑量%吡咯類/投藥和劑量%心肌梗死/病理生理學/藥物療法%血小闆/藥物作用%心室重構/藥物作用
경산류/투약화제량%필각류/투약화제량%심기경사/병리생이학/약물요법%혈소판/약물작용%심실중구/약물작용
Heptanoic acids/AD%Pyrroles/AD%Myocardial infarction/PP/DT%Blood platelets/DE%Ventricular remodeling/DE
目的 评价负荷剂量联合高维持剂量阿托伐他汀治疗对急性ST段抬高心肌梗死(STEMI)患者血小板活化参数以及接受直接经皮冠状动脉介入(PCI)治疗后心室重构的影响与机制.方法 选择2012年6月至2013年12月在本院心内科住院并诊断为STEMI的患者260例,随机分为对照组(常规剂量组)140例及高剂量他汀组120例,检测患者直接PCI术前及术后平均血小板体积(MPV)、大血小板比例(P-LCR)、血小板活化指标CD62p、糖蛋白(Gp)Ⅱb/Ⅲa受体复合物(PAC-1)水平,记录直接PCI术后患者心肌灌注指标TIMI心肌灌注分级(TMPG);患者于术后5～7d及出院6个月后行超声心动图测定左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室质量指数(LVMI)及左室射血分数(LVEF).术后对患者随访6个月,动态追踪观察两组患者随访期内肝功能损害、肌病及心血管不良事件(MACE)的发生情况.结果 高剂量组患者术后MPV、P-LCR、CD62p 、PAC-1等血小板活化参数均低于对照组[(12.96±1.73)fl vs (14.18±1.86)fl,P＜0.05;(29.12±5.83)％ vs (30.66 ±6.12)％,P＜0.05;(45.36±5.24)％ vs (48.44±4.75)％,P＜0.01;(74.61±5.57)％ vs (78.55±5.78)％,P＜0.01],术后TMPG良好比例显著高于对照组(73.3％ vs 58.6％,P＜0.01),出院6个月后,高剂量组患者LVEDV、LVESV、LVMI显著小于对照组,而LVEF则高于对照组[(110.46±8.86)ml vs(112.61±8.5)ml,P＜0.01;(60.16±6.13)ml vs(63.52±5.54)ml,P＜0.01;(101.69±4.35)g/m2 vs (103.96±4.17)g/m2,P＜0.05;(50.08±3.78)％ vs (48.47±4.12)％,P＜0.05],随访期间两组患者肝功能损害及肌病的发生情况差异无统计学意义(P＞0.05),Kaplan-Meier生存分析显示高剂量组患者累积无MACE事件生存率显著高于对照组,Log rank检验差异有统计学意义(91.7％ vs 82.4％,Log rank =4.409,P=0.036).结论 对STEMI患者应用高剂量他汀能显著降低患者血小板活化程度,改善直接PCI术后心肌灌注并减轻左心室重构,减少不良心血管事件的发生且具有良好的安全性.
目的 評價負荷劑量聯閤高維持劑量阿託伐他汀治療對急性ST段抬高心肌梗死(STEMI)患者血小闆活化參數以及接受直接經皮冠狀動脈介入(PCI)治療後心室重構的影響與機製.方法 選擇2012年6月至2013年12月在本院心內科住院併診斷為STEMI的患者260例,隨機分為對照組(常規劑量組)140例及高劑量他汀組120例,檢測患者直接PCI術前及術後平均血小闆體積(MPV)、大血小闆比例(P-LCR)、血小闆活化指標CD62p、糖蛋白(Gp)Ⅱb/Ⅲa受體複閤物(PAC-1)水平,記錄直接PCI術後患者心肌灌註指標TIMI心肌灌註分級(TMPG);患者于術後5～7d及齣院6箇月後行超聲心動圖測定左室舒張末期容積(LVEDV)、左室收縮末期容積(LVESV)、左室質量指數(LVMI)及左室射血分數(LVEF).術後對患者隨訪6箇月,動態追蹤觀察兩組患者隨訪期內肝功能損害、肌病及心血管不良事件(MACE)的髮生情況.結果 高劑量組患者術後MPV、P-LCR、CD62p 、PAC-1等血小闆活化參數均低于對照組[(12.96±1.73)fl vs (14.18±1.86)fl,P＜0.05;(29.12±5.83)％ vs (30.66 ±6.12)％,P＜0.05;(45.36±5.24)％ vs (48.44±4.75)％,P＜0.01;(74.61±5.57)％ vs (78.55±5.78)％,P＜0.01],術後TMPG良好比例顯著高于對照組(73.3％ vs 58.6％,P＜0.01),齣院6箇月後,高劑量組患者LVEDV、LVESV、LVMI顯著小于對照組,而LVEF則高于對照組[(110.46±8.86)ml vs(112.61±8.5)ml,P＜0.01;(60.16±6.13)ml vs(63.52±5.54)ml,P＜0.01;(101.69±4.35)g/m2 vs (103.96±4.17)g/m2,P＜0.05;(50.08±3.78)％ vs (48.47±4.12)％,P＜0.05],隨訪期間兩組患者肝功能損害及肌病的髮生情況差異無統計學意義(P＞0.05),Kaplan-Meier生存分析顯示高劑量組患者纍積無MACE事件生存率顯著高于對照組,Log rank檢驗差異有統計學意義(91.7％ vs 82.4％,Log rank =4.409,P=0.036).結論 對STEMI患者應用高劑量他汀能顯著降低患者血小闆活化程度,改善直接PCI術後心肌灌註併減輕左心室重構,減少不良心血管事件的髮生且具有良好的安全性.
목적 평개부하제량연합고유지제량아탁벌타정치료대급성ST단태고심기경사(STEMI)환자혈소판활화삼수이급접수직접경피관상동맥개입(PCI)치료후심실중구적영향여궤제.방법 선택2012년6월지2013년12월재본원심내과주원병진단위STEMI적환자260례,수궤분위대조조(상규제량조)140례급고제량타정조120례,검측환자직접PCI술전급술후평균혈소판체적(MPV)、대혈소판비례(P-LCR)、혈소판활화지표CD62p、당단백(Gp)Ⅱb/Ⅲa수체복합물(PAC-1)수평,기록직접PCI술후환자심기관주지표TIMI심기관주분급(TMPG);환자우술후5～7d급출원6개월후행초성심동도측정좌실서장말기용적(LVEDV)、좌실수축말기용적(LVESV)、좌실질량지수(LVMI)급좌실사혈분수(LVEF).술후대환자수방6개월,동태추종관찰량조환자수방기내간공능손해、기병급심혈관불량사건(MACE)적발생정황.결과 고제량조환자술후MPV、P-LCR、CD62p 、PAC-1등혈소판활화삼수균저우대조조[(12.96±1.73)fl vs (14.18±1.86)fl,P＜0.05;(29.12±5.83)％ vs (30.66 ±6.12)％,P＜0.05;(45.36±5.24)％ vs (48.44±4.75)％,P＜0.01;(74.61±5.57)％ vs (78.55±5.78)％,P＜0.01],술후TMPG량호비례현저고우대조조(73.3％ vs 58.6％,P＜0.01),출원6개월후,고제량조환자LVEDV、LVESV、LVMI현저소우대조조,이LVEF칙고우대조조[(110.46±8.86)ml vs(112.61±8.5)ml,P＜0.01;(60.16±6.13)ml vs(63.52±5.54)ml,P＜0.01;(101.69±4.35)g/m2 vs (103.96±4.17)g/m2,P＜0.05;(50.08±3.78)％ vs (48.47±4.12)％,P＜0.05],수방기간량조환자간공능손해급기병적발생정황차이무통계학의의(P＞0.05),Kaplan-Meier생존분석현시고제량조환자루적무MACE사건생존솔현저고우대조조,Log rank검험차이유통계학의의(91.7％ vs 82.4％,Log rank =4.409,P=0.036).결론 대STEMI환자응용고제량타정능현저강저환자혈소판활화정도,개선직접PCI술후심기관주병감경좌심실중구,감소불양심혈관사건적발생차구유량호적안전성.
Objective To investigate the effects of high dose atovastatin administration on platelet activity and ventricular remodeling of patients with ST-Segment elevation myocardial infarction (STEMI) underwent primary percutaneous coronary intervention (PCI).Methods A total of 260 STEMI patients who hospitalized in our Department of Cardiology from June 2012 to December 2013 was enrolled and randomly divided into two groups:controlled group (n =140) and high dose atorvastatin group (n =120).Indicators of platelet activities including mean platelet volume (MPV),platelet large cell ratio (P-LCR),blood CD62p,and glucose protein Ⅱ b/Ⅲa (PAC-1) were measured before and 48 hours after PCI.TIMI myocardial perfusion grade (TMPG) after PCI was recorded and patients accepted ultrasound cardiogram (UCG) examinations 5 ～7 days after PCI and 6 months after discharge.After PCI,Patients were followed up for 6 months,statin-associated liver impairment,myopath and major adverse cardiac events (MACE) happened during follow-up periods were recorded.Results MPV,P-LCR,CD62p,and PAC-1 in patients of high dose atorvastatin group were less than controlled group and TMPG were better than controlled group [(12.96±1.73)fl vs (14.18 ± 1.86)fl,P ＜0.05;(29.12 ±5.83)％ vs (30.66 ±6.12)％,P ＜ 0.05;(45.36±5.24)％ vs (48.44±4.75)％,P ＜0.01;(74.61 ±5.57)％ vs (78.55±5.78)％,P ＜0.01].Six months after PCI,UCG examination showed that Left ventricular end-diastolic volume (LV-EDV),left ventricular end-systolic volume (LVESV) and left ventricular mass index (LVMI) in high dose group were less than controlled group while the left ventricular ejection fraction (LVEF) was higher than controlled group [(110.46 ±8.86)ml vs (112.61 ±8.5)ml,P ＜0.01;(60.16 ±6.13)ml vs (63.52 ± 5.54)ml,P ＜0.01;(1O1.69±4.35)g/m2 vs (103.96 ±4.17)g/m2,P ＜0.05;(50.08 ±3.78)％ vs (48.47 ± 4.12) ％,P ＜ 0.05].After 6 months of follow-up,the incidence rate of statin-associated liver impairment and myopathe had no significant difference between two groups and Kaplan-Meier survival analysis showed patients of two groups had significantly different cumulative non-events survival rates (91.7％ vs 82.4％,Log rank =4.409,P =O.036).Conclusions Loading dose atorvastatin before PCI combined high maintenance dose after PCI can inhibit platelet activation and improve myocardial perfusion levels of patients with STEMI underwent primary PCI.It also can reduce Left ventricular remodeling and improve patient's prognosis without increasing side effects.
