不同剂量阿托伐他汀对STEMI患者PCI术后心功能及血小板功能的影响-现代医学

不同剂量阿托伐他汀对STEMI患者PCI术后心功能及血小板功能的影响

单位：新疆军区总医院心内科, 新疆乌鲁木齐 830001

分类号：R541.4

出版年·卷·期（页码）：2018·46·第四期（370-375）

摘要：

目的：探讨不同剂量阿托伐他汀对急性ST段抬高型心肌梗死（STEMI）患者行经皮冠状动脉介入治疗（PCI）术后心功能及血小板功能的影响。方法：将我院收治的186例STEMI行急诊PCI术患者按随机数字表法平均分为3组，分别给予不同剂量阿托伐他汀治疗：Ⅰ组术后予20 mg·d^-1，Ⅱ组术后予40 mg·d^-1、1个月后予20 mg·d^-1，Ⅲ组术前予80 mg、术后予40 mg·d^-1、1个月后予20 mg·d^-1。观察3组患者治疗前后血脂、血小板功能、脑钠肽（BNP）、左室射血分数（LVEF）、左室舒张末期内径（LVEDD）变化情况，并对随访6个月后临床事件发生情况进行比较。结果：治疗1周后，3组患者血脂均有所下降（P>0.05），二磷酸腺苷（ADP）诱导的血小板-纤维蛋白凝块强度（MAADP）较治疗前明显降低（P<0.05），Ⅱ、Ⅲ组明显低于Ⅰ组（P<0.05）；Ⅱ、Ⅲ组的ADP高反应性发生率、ADP和花生四烯酸（AA）均高反应性发生率均低于Ⅰ组（P<0.05）；治疗后1周、1个月、6个月，3组BNP较治疗前均有所下降，且Ⅲ组下降更明显（P<0.05）；治疗后6个月，LVEF Ⅲ组>Ⅱ组（P>0.05），Ⅲ、Ⅱ组>Ⅰ组（P<0.05）；Ⅰ、Ⅱ组患者治疗后LVEDD水平变化小（P>0.05），Ⅲ组治疗后6个月LVEDD水平低于治疗后2 d（P<0.05）。治疗后6个月随访时，3组临床事件发生情况比较差异无统计学意义（P>0.05）。结论：STEMI患者PCI术前使用负荷剂量的阿托伐他汀治疗，可抑制血小板活性，改善左心室收缩功能。

Objective: To investigate the effects of different doses of atorvastatin on cardiac and platelet function in patients with acute ST elevation myocardial infarction(STEMI) after percutaneous coronary intervention(PCI). Methods: One hundred and eighty-six patients with STEMI undergoing emergency PCI in our hospital were selected as research subjects and were divided into three groups by random number table. Each group was treated with different doses of atorvastatin. Group Ⅰ was given 20 mg·d^-1 after operation; group Ⅱ was given 40 mg·d^-1 after operation and then 20 mg·d^-1 one month after operation, and group Ⅲ was respectively given 80 mg before operation, 40 mg·d^-1 after operation, and 20 mg·d^-1 one month after operation. The changes of blood lipid, platelet function, brain natriuretic peptide(BNP), left ventricular ejection fraction(LVEF) and left ventricular end diastolic diameter(LVEDD) were observed before and after treatment,and the clinical events after 6 months of follow-up were compared. Results: After 1 week of treatment, the blood lipids of the 3 groups decreased(P>0.05). The maximum amplitude induced by adenosine diphosphate(MAADP) was significantly lower than that before treatment(P<0.05), and the MAADP of group Ⅱ and group Ⅲ were significantly lower than that of group Ⅰ(P<0.05). The hyper reactivity incidence of ADP, and both ADP and arachidonic acid(AA) was lower than that in group Ⅰ(P<0.05). After treatment for 1 week, 1 month and 6 months, the BNP decreased compared with that before treatment, and the decrease in group Ⅲ was more obvious(P<0.05). After 6 months of treatment, LVEF of the three groups was found in the following order:group Ⅲ>group Ⅱ(P>0.05), group Ⅲ, group Ⅱ>group Ⅰ(P<0.05). In group Ⅰ and Ⅱ, the level of LVEDD had not changed significantly after treatment(P>0.05), and the level of LVEDD in group Ⅲ in 6 months after treatment was lower than that at two days after treatment(P<0.05).After treatment, no significantly statistical difference of the clinical events was found in the three groups during the 6-month follow up(P>0.05). Conclusion: For STEMI patients, administration of loading dose of atorvastatin before PCI can inhibit platelet activity and improve left ventricular systolic function.

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