Effect of intensive atorvastatin on the levels of Lp-PLA2, IL-6 and TNF-α in patients with acute ST segment elevation myocardial infarction in emergency percutaneous coronary intervention during perioperative period
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摘要: 目的:分析急诊经皮冠状动脉介入术(PCI)围手术期强化阿托伐他汀治疗对急性ST段抬高型心肌梗死(ASTEMI)患者肝功能和炎症细胞因子水平的影响。方法:选取76例行急诊PCI治疗的ASTEMI患者,分为对照组(35例)和研究组(41例)。对照组术前顿服阿托伐他汀20 mg,术后继续口服阿托伐他汀20 mg;研究组术前顿服阿托伐他汀40 mg,术后继续给予阿托伐他汀40 mg进行强化治疗。比较两组手术前后肝酶指标、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、IL-6及脂蛋白相关磷脂酶A2(Lp-PLA2)。结果:相比术前,两组术后2周时LDL-C、TG、TC含量均明显降低(P<0.05),HDL-C明显升高(P<0.05);研究组优于对照组(P<0.05)。相比术前,两组术后3 d天门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)及肌酸激酶同工酶(CK-MB)均明显增高(P<0.05);两组3 d时AST、ALT及CK-MB含量的比较,均差异无统计学意义(P>0.05)。与术前比较,两组术后3 d时TNF-α、IL-6、Lp-PLA2及hs-CRP含量均明显增高(P<0.05);与对照组比较,研究组术后3 d时TNF-α、IL-6、Lp-PLA2及hs-CRP含量均明显下降(P<0.05)。两组不良反应发生率的比较,差异无统计学意义(P>0.05)。结论:围手术期应用阿托伐他汀强化治疗有助于抑制ASTEMI患者急诊PCI治疗后炎症反应,对于高龄老年患者、基础血脂不高者,强化调脂更应慎重。
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关键词:
- 急性ST段抬高型心肌梗死 /
- 经皮冠状动脉介入术 /
- 阿托伐他汀 /
- 肝功能 /
- 炎症反应
Abstract: Objective: To analyze the effect of enhanced atorvastatin treatment on liver function and inflammatory cytokines in patients with acute ST segment elevation myocardial infarction(ASTEMI) before and after percutaneous coronary intervention(PCI).Methods: Seventy-six patients with ASTEMI were divided into control group(35 cases) and study group(41 cases). The control group received 20 mg of atorvastatin before operation and continued to take 20 mg of atorvastatin after operation; the study group received 40 mg of atorvastatin before operation and continued to receive 40 mg of atorvastatin after operation for intensive treatment. The liver enzyme index, hypersensitive C-reactive protein, TNF-α, IL-6 and lipoprotein-associated phospholipaseA2(Lp-PLA2) were compared before and after operation.Results: Compared with before operation, the levels of LDL-C, TG and TC in two groups were significantly decreased(P<0.05), and HDL-C was significantly increased(P<0.05); the study group was better than the control group(P<0.05). Compared with before operation, aspartate aminotransferase(AST), alanine transaminase(ALT) and creatinekinase isoenzyme MB(CK-MB) of the two groups were significantly higher on the 3 rd day after operation(P<0.05); there was no significant difference in AST, ALT and CK-MB between the two groups on the 3 rd day(P>0.05). The levels of TNF-α, IL-6, Lp-PLA2and hs-CRP in the two groups were significantly higher than those in the control group(P<0.05), and the levels of TNF-α, IL-6, Lp-PLA2and CRP in the study group were significantly lower than those in the control group(P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion: Perioperative intensive treatment with atorvastatin can inhibit the inflammatory response of astemi patients after emergency PCI. It should be more cautious to strengthen lipid regulation for elderly patients and patients with low basic blood lipid. -
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