阿托伐他汀对ST段抬高型急性心肌梗死患者急诊PCI术后无复流现象的影响被引量：41

Effects of atorvastatin in ST-elevation myocardial infarction patients with no reflow phenomenon after primary percutaneous coronary intervention

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摘要目的:探讨长期应用阿托伐他汀对冠状动脉介入治疗(PCI)术后无复流发生率的影响。方法:入选对象均为ST段抬高型急性心肌梗死(STEMI)患者,接受急诊PCI治疗且至少口服阿托伐他汀10mg/d3个月以上者入选阿托伐他汀组,未服用任何调脂药物者入选对照组,连续入选,至每组60例为止。PCI术中根据TI-MI血流分级法(TFG)、TIMI计帧法(cTFC)评价冠状动脉血流。术后24h进行实时心肌声学造影检查,计算心肌灌注缺损计分指数(CSI)及室壁运动计分指数(WMSI)。术后30min及24h记录心电图,观察ST段抬高最显著导联ST段回落的情况。术前、术后24h采取静脉血测定血浆高敏C反应蛋白(Hs-CRP)及sICAM-1水平。结果:阿托伐他汀组TIMI3级血流者显著多于对照组(P<0.05),而cTFC显著低于对照组(P<0.01)。阿托伐他汀组与对照组相比CSI(1.22±0.33:1.37±0.42,P<0.05),WMSI(1.53±0.40:1.71±0.38,P<0.05)均显著降低。术后30min阿托伐他汀组ST段回落≥50%者显著多于对照组(P<0.05),术后24h差异无统计学意义。术前、术后24h阿托伐他汀组血浆Hs-CRP及sICAM-1均显著低于对照组。结论:长期应用阿托伐他汀能够明显改善PCI术后心肌血流,防止无复流的发生,其机制与阿托伐他汀的调脂效应及调脂外效应密切相关。 Objective：To investigate whether long term use of atorvastatin could reduce the incidence of no reflow phenomenon after primary percutaneous coronary intervention（PCI）.Method：The patients taken atorvastatin at least 10 mg daily for 3 months before ST-elevation myocardial infarction（STEMI） and primary PCI were assigned to atorvastatin group（n=60）.The patients without antilipemic agent before STEMI and primary PCI were assigned to the control group（n=60）.TIMI flow grade（TFG） and corrected TIMI frame count（cTFC） were used to evaluate coronary flow during PCI.Real time myocardial contrast echocardiography（RT-MCE） was examined then contrast score index（CSI） and wall motion scores index（WMSI） were calculated 24 hours after PCI.Electrocardiography was performed to analysis ST segment resolution 30 minutes and 24 hours after PCI.Venous blood was obtained before and 24 hours after PCI to test the level of HsCRP and sICAM-1 in plasma.Result：The ratio of blood flow reaching to TIMI3 was significantly higher in atorvastatin group as compared to control group（P0.05）.The value of cTFC in atorvastatin group is significantly lower than that in control group（P0.01）.Compared to control group,CSI（1.22±0.33：1.37±0.42,P0.05） and WMSI（1.53±0.40：1.71±0.38,P0.05） were all significantly lower in atorvastatin group.The ratio of ST segment reduction over 50% in atorvastatin group were significantly higher than that in control group 30 minutes after PCI（P0.05）;However there was no significant difference between the two groups 24 hours after PCI.Both plasma HsCRP and sICAM-1 in atorvastatin group were significantly lower than control group before or 24 hours after PCI.Conclusion：These results suggest that long term use of atovastatin can significantly improve myocardial perfusion and reduce no reflow phenomenon post PCI.The underlying mechanism involves the lipid lowering effect and the effect beyond lipid lowering.

作者杨树森甘润韬孙延明王政董国潘薇

机构地区哈尔滨医科大学附属第一临床医院心内科

出处《临床心血管病杂志》 CAS CSCD 北大核心 2011年第1期35-38,共4页 Journal of Clinical Cardiology

关键词心肌梗死阿托伐他汀 PCI 无复流 myocardial infarction atorvastatin percutaneous coronary intervention no-reflow

分类号 R542.2 [医药卫生—心血管疾病]

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