长期服用他汀的稳定型心绞痛患者PCI术前单次负荷剂量阿托伐他汀对心肌损伤的影响

冠状动脉粥样硬化性心脏病；经皮冠状动脉介入治疗；肌钙蛋白；阿托伐他汀

摘要:

目的  探讨长期服用他汀的稳定型心绞痛患者经皮冠状动脉介入治疗（PCI）术前给予单次负荷剂量80 mg阿托伐他汀对心肌损伤及炎症反应的影响。方法  将85例择期行PCI且术前服用常规剂量他汀类药物>30 d的稳定型心绞痛患者随机分为两组，PCI前8～12 h服用阿托伐他汀，剂量分别为20 mg（常规剂量组）42例，80 mg（负荷剂量组）43例，观察两组患者术后8和24 h肌酸激酶同工酶（CK-MB）、超敏肌钙蛋白T（cTnT）、超敏C-反应蛋白（hs-CRP）等指标变化。结果  ①常规剂量组术后8和24 h CK-MB、cTnT、hs-CRP高于术前，以术后24 h升高明显；②负荷剂量组术后24h CK-MB、cTnT、hs-CRP高于术前；③负荷剂量组术后24 h CK-MB、cTnT、hs-CRP低于常规剂量组。结论  长期服用他汀类药物治疗的稳定型心绞痛患者PCI术前给予80 mg负荷剂量阿托伐他汀对心肌具有保护作用。

Abstract:

Objective To observe the myocardial protection effect of single high loading dose of 80 mg Atorvastatin before percutaneous coronary intervention (PCI) in patients accepting chronic Statin treatment for stable angina pectoris (SAP). Methods A total of 85 SAP patients who had received long-term Statin therapy were randomly assigned into conventional-dose group (given 20 mg Atorvastatin) and load-dose group (given 80 mg Atorvastatin). The patients received intensive pretreatment of Atorvastatin within 8-12 h before PCI. The changes of postoperative creatine kinase isoenzyme (CK-MB), cardiac troponin T (cTnT) and high-sensitivity C-reactive protein (hs-CRP) were observed 8 h and 24 h after PCI. Results In the conventional-dose group, the levels of CK-MB, cTnT and hs-CRP significantly increased at 8 h and 24 h after PCI compared with the preoperative levels. In the loading-dose group, the levels of CK-MB, cTnT and hs-CRP significantly increased at 24 h after PCI compared with the preoperative levels. In the loading-dose group, the levels of CK-MB, cTnT and hs-CRP significantly decreased at 24 h after PCI compared with the conventional-dose group. Conclusions Single high loading dose of 80 mg Atorvastatin given prior to PCI has myocardial protection in patients with stable angina pectoris receiving chronic Statin treatment.