CAJ | 학술논문

目的：分析经皮冠状动脉介入术（PCI）术前不同负荷量阿托伐他汀对急性冠脉综合征（ACS）患者1年预后的影响。方法入选2012年11月至2013年2月于中国人民解放军白求恩国际和平医院心内科住院并成功行PCI术的ACS患者101例，男性72例，女性29例。随机分为3组，对照组仅给予阿托伐他汀维持量治疗，即20 mg/d。40 mg组和80 mg组术前1 d均给予80 mg阿托伐他汀，术前即刻再分别给予40 mg、80 mg阿托伐他汀。术前及术后1年复查生化指标。随访1年终点事件，包括心绞痛复发、心源性死亡、心源性再住院等。结果对照组较40 mg组和80 mg组终点事件的总发生率增加，为40.0%vs.16.1%和40.0% vs.13.3%，差异有统计学意义（P均＜0.05）。40 mg组和80 mg组的1年累积风险均明显低于对照组，差异有统计学意义（P均＜0.05）。PCI术前给予负荷量阿托伐他汀仍是心绞痛复发的独立保护因素。与对照组相比，40 mg组和80 mg组分别使1年内心绞痛复发风险降低67.3%和68.9%。与对照组术后相比，40 mg组和80 mg组高敏C反应蛋白水平均降低，差异有统计学意义（P均＜0.05）。未发生横纹肌溶解综合征。40 mg组1例患者出现术后谷丙转氨酶＞3倍正常高限，停用后恢复正常。结论 PCI术前两次给予阿托伐他汀可明显改善急性冠脉综合征患者1年预后。
목적：분석경피관상동맥개입술（PCI）술전불동부하량아탁벌타정대급성관맥종합정（ACS）환자1년예후적영향。방법입선2012년11월지2013년2월우중국인민해방군백구은국제화평의원심내과주원병성공행PCI술적ACS환자101례，남성72례，녀성29례。수궤분위3조，대조조부급여아탁벌타정유지량치료，즉20 mg/d。40 mg조화80 mg조술전1 d균급여80 mg아탁벌타정，술전즉각재분별급여40 mg、80 mg아탁벌타정。술전급술후1년복사생화지표。수방1년종점사건，포괄심교통복발、심원성사망、심원성재주원등。결과대조조교40 mg조화80 mg조종점사건적총발생솔증가，위40.0%vs.16.1%화40.0% vs.13.3%，차이유통계학의의（P균＜0.05）。40 mg조화80 mg조적1년루적풍험균명현저우대조조，차이유통계학의의（P균＜0.05）。PCI술전급여부하량아탁벌타정잉시심교통복발적독립보호인소。여대조조상비，40 mg조화80 mg조분별사1년내심교통복발풍험강저67.3%화68.9%。여대조조술후상비，40 mg조화80 mg조고민C반응단백수평균강저，차이유통계학의의（P균＜0.05）。미발생횡문기용해종합정。40 mg조1례환자출현술후곡병전안매＞3배정상고한，정용후회복정상。결론 PCI술전량차급여아탁벌타정가명현개선급성관맥종합정환자1년예후。
Objective To analyze the influence of different loading doses of atorvastatin on 1-year prognosis in patients with acute coronary syndrome (ACS) before percutaneous coronary intervention (PCI). Methods ACS patients undergone successful PCI (n=101, male 72 and female 29) were chosen from Nov. 2012 to Feb. 2013, and randomly divided into 3 groups. The control group was given maintaining dose of atorvastatin (20 mg/d), and 40 mg group and 80 mg group were given atorvastatin (80 mg/d) 1 d before PCI and 40 mg/d and 80 mg/d respectively immediately just before PCI. The biochemical indexes were detected before and 1 y after PCI. The endpoint events including recurrence of angina pectoris, cardiac death and cardiac re-admission were followed up after 1 y. Results The total incidence of endpoint events increased in control group compared with 40 mg group (40.0%vs. 16.1%) and 80 mg group (40.0%vs. 13.3%, all P<0.05). In 40 mg group and 80 mg group, 1-year accumulative risk was significantly lower than that in control group (all P<0.05). The loading dose of atorvastatin before PCI was an independent protective factor of recurrence of angina pectoris. The recurrence risk of angina pectoris within 1 y was decreased by 67.3%in 40 mg group and by 68.9%in 80 mg group compared with control group. After PCI, the level of high-sensitivity C-reactive protein decreased in 40 mg group and 80 mg group compared with control group (all P<0.05). There was no case with rhabdomyolysis. There was 1 patients with alanine aminotransferase (ALT) higher 3 times than normal high limit in 40 mg group and recovered to normal after stopping mediation. Conclusion Giving atorvastatin 2 times before PCI can significantly improve 1-y prognosis in patients with ACS.