他汀对急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后炎性反应及心肌重构的影响

发布时间：2018-04-18 16:25

本文选题：他汀 + 急性ST段抬高型心肌梗死　；参考：《复旦大学》2014年博士论文

【摘要】：背景：他汀具有独立于降脂功能的多效性作用,它可能通过其抗炎效应减轻患者经皮冠状动脉介入治疗(PCI)术后冠状动脉微栓塞,进而改善患者远期心肌重构和临床预后。本研究旨在探讨直接PCI术前单次应用负荷剂量瑞舒伐他汀强化治疗能否改善急性ST段抬高型(STEMI)心肌梗死患者的术后炎性反应和心肌重构。方法：49位被诊断为STEMI、梗死相关动脉为左前降支的患者被分入他汀组(n=10,59±13岁,90%男性)和对照组(n=39,61±12岁,82%男性),分别在直接PCI术前一次性给予瑞舒伐他汀40mg负荷剂量或不给予他汀类药物治疗,所有患者在术后接受瑞舒伐他汀常规剂量10mg/d治疗。主要终点为直接PCI术后30天主要不良心血管事件(MACE)发生率,包括心源性死亡、非致命性再次心肌梗死和再次靶血管血运重建,次要终点为术后12个月MACE发生率。在直接PCI术前、术后12h、36h和60h分别检测所有患者的血清肌酸激酶-MB亚型(CK-MB)、肌钙蛋白T(cTnT)、单核细胞趋化蛋白-1(MCP-1)、基质金属蛋白酶-9(MMP-9)、基质金属蛋白酶抑制因子-1(TIMP-1)和骨桥蛋白(OPN)浓度。所有患者在直接PCI术后1周和12个月接受超声心动图检查。结果：两组患者的基线临床特征没有显著性差异。直接PCI术后30天对照组患者MACE发生率5.1%,他汀组未发生MACE,不具有统计学差异。两组患者CK-MB和cTnT峰值及各个时间点的浓度均无显著性差异。两组患者在直接PCI术前的血清MCP-1浓度、MMP-9/TIMP-1比值无显著差异,但他汀组患者的MCP-1水平在术后36h (5.87±14.47 vs.86.25±23.02 pg/ml, p0.001)及术后60h (62.34±13.11 vs.85.33±23.21pg/ml, p=0.01)明显低于对照组,MMP-9/TIMP-1比值在术后60h与对照组相比显著降低(35.15±9.14 vs.45.67±9.76,p=0.009)。两组患者的血清OPN浓度在各个时间点无显著性差异。两组患者在直接PCI术后1周的左室射血分数(LVEF)、左室舒张末期容积(LVEDV)和左室收缩末期容积(IVESV)无显著性差异。结论：STEM1患者直接PCI术前给予单次负荷剂量瑞舒伐他汀强化治疗,对改善术后30天MACE发生率未得到显著性差异,但可以抑制术后炎性反应并在一定程度上改善心肌重构。
[Abstract]:Background: statins have multiple effects independent of lipid-lowering function. It may alleviate coronary microembolism after percutaneous coronary intervention (PCI) and improve long-term myocardial remodeling and clinical prognosis through its anti-inflammatory effect.The purpose of this study was to investigate whether a single dose of resuvastatin before direct PCI could improve postoperative inflammatory response and myocardial remodeling in patients with acute ST-segment elevation (STEMI) myocardial infarction.Methods Forty-nine patients diagnosed as STEMI with infarct related artery as left anterior descending artery were divided into statin group (1059 卤13 years old, 90% male) and control group (39 61 卤12 years old, 82% men). They were given resuvastatin 40mg load dose or not before direct PCI.The treatment of statins,All patients were treated with conventional dose of 10mg/d after operation.The main endpoint was the incidence of major adverse cardiovascular events (PCI) 30 days after direct PCI, including cardiac death, non-fatal re-myocardial infarction and re-target revascularization. The secondary endpoint was the incidence of MACE 12 months after operation.The serum levels of creatine kinase MB subtype CK-MBN, troponin TnTnT, monocyte chemoattractant protein (MCP-1), matrix metalloproteinase-9 (MMP-9), matrix metalloproteinase-1 (MMP-1) and osteopontin (OPN) were measured before and 12 hours after direct PCI.All patients underwent echocardiography 1 week and 12 months after direct PCI.Results: there was no significant difference in baseline clinical features between the two groups.30 days after direct PCI, the incidence of MACE in the control group was 5.1 and no significant difference was found in the statin group.There was no significant difference in the peak values of CK-MB and cTnT and the concentrations at each time point between the two groups.There was no significant difference in serum MCP-1 concentration and MMP-9 / TIMP-1 ratio between the two groups before direct PCI, but the level of MCP-1 in the statin group was significantly lower than that in the control group (P 0.001) at 36h (5.87 卤14.47 vs.86.25 卤23.02 PG / ml) and 60 h after operation (62.34 卤13.11 vs.85.33 卤23.21pg / ml, p0.01), which was significantly lower than that in the control group at 60h after operation (35.15 卤9.14 vs.45.67 卤9.7p0.009).There was no significant difference in serum OPN concentration between the two groups at all time points.There was no significant difference in left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEF) and left ventricular end-systolic volume (LVV) between the two groups at 1 week after direct PCI.Conclusion there was no significant difference in the incidence of MACE 30 days after operation in patients with direct PCI treated with single dose of resuvastatin before operation, but it could inhibit the inflammatory response and improve myocardial remodeling to a certain extent.
【学位授予单位】：复旦大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R542.22

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