不同剂量阿托伐他汀对急性ST段抬高型心肌梗死患者血小板反应性的影响

发布时间：2018-02-12 08:41

本文关键词： 心肌梗死降血脂药血小板　出处：《中国循环杂志》2017年01期 　论文类型：期刊论文

【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)患者行急诊经皮冠状动脉(冠脉)介入治疗(PCI)后残余血小板功能和血小板反应性的影响。方法 :行急诊PCI的120例STEMI患者按随机数字表随机分成阿托伐他汀20 mg/d治疗组(标准组,n=60)、阿托伐他汀40 mg/d治疗组(强化组,n=60)。120例患者分别于急诊PCI前及他汀药物治疗后第7天取血,行血脂及生化检测。并通过血栓弹力图测定二磷酸腺苷(ADP)诱导的血小板纤维蛋白凝块强度(MAADP)和花生四烯酸(AA)和ADP诱导的血小板抑制率。结果:经血栓弹力图检测的MAADP值在治疗7天后,强化组较标准组明显下降[(38.40±17.40)mm vs(45.70±14.50)mm,P0.05],差异有统计学意义。于治疗第7天ADP高反应性的发生率在强化组较标准组明显较少(18.3%vs 31.7%,P0.05)。AA高反应性的发生率在强化组和标准组无差异(13.3%vs 18.3%,P0.05)。随访3个月临床终点事件(包括不稳定性心绞痛,非致死性心肌梗死,支架内再狭窄,支架内血栓及心血管疾病死亡或靶血管重建)在两组间差异均无统计学意义(P0.05)。结论:STEMI患者急诊PCI后早期给予短疗程的高剂量他汀治疗较常规剂量可更显著地抑制血小板活性,降低血小板高反应性。强化治疗3个月临床终点事件未出现显著下降。
[Abstract]:Objective: to investigate the effects of different doses of Atto vastatin on residual platelet function and platelet reactivity in patients with acute ST-segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI). 120 patients with STEMI undergoing emergency PCI were randomly divided into two groups: the Atto vastatin 20 mg/d treatment group (standard group) and Atto vastatin 40 mg/d treatment group. The thromboelastography was used to determine the platelet fibrin clot strength induced by adenosine diphosphate (ADP), arachidonic acid (AA) and platelet inhibition rate induced by ADP. Results: thromboelastography was used to detect the platelet inhibition rate. After 7 days of treatment, The incidence of ADP hyperresponsiveness in the enhancement group was significantly lower than that in the standard group [38.40 卤17.40mm vs(45.70 卤14.50mm] on the 7th day of treatment, there was no significant difference between the enhancement group and the standard group in the incidence of hyperreactivity of ADP compared with the standard group. The clinical end point events (including unstable angina pectoris) were followed up for 3 months. Non-fatal myocardial infarction, stent restenosis, There was no significant difference between the two groups in thrombus and cardiovascular disease death or target vascular remodeling. Conclusion the early short course of high dose statins can significantly inhibit platelet activity after emergency PCI in patients with PCI. Reduction of platelet hyperresponsiveness. 3 months after intensive therapy, no significant decrease in clinical endpoint events was observed.
【作者单位】：首都医科大学附属北京朝阳医院心脏中心;
【分类号】：R542.22

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