PCI术前服用负荷剂量他汀对围手术期心肌保护作用的回顾性研究
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摘要
目的:通过分析经皮冠状动脉介入治疗(PCI)术前服用不同剂量他汀类药物后患者心肌损伤指标变化,探究PCI术前服用负荷剂量他汀类药物对患者围手术期心肌是否具有保护作用。方法:收集某院2013-2017年PCI患者病例共752例。比较分析5组患者(A组:长期他汀类药物治疗+术前单次服用负荷剂量他汀,B组:长期他汀类药物治疗+术前单次服用常规剂量他汀,C组:术前单次服用负荷剂量他汀,D组:术前单次服用常规剂量他汀,E组:术前无他汀类药物治疗)术前,术后0～2 h、3～12 h、13～24 h的cTn I、CK-MB、AST、ALT、BUN、sCr指标以及住院期间MACE发生率。结果:A、B、C组术后cTn I和CK-MB升高幅度及住院期间MACE发生率显著低于D、E组(P<0.05);5组AST、ALT较术前显著升高(P<0.05),但未高过正常指标上限的3倍;5组BUN、sCr较术前升高不明显(P>0.05)。结论:PCI术前长期他汀类药物治疗或术前单次服用负荷剂量他汀类药物能够减少围手术期的心肌损伤,降低住院期间MACE发生率且对肝肾功能无显著影响。
OBJECTIVE To investigate the perioperative myocardial protection of statins at a loading dose before percutaneous coronary intervention(PCI),by analyzing the changes of myocardial injury indexes in patients after taking different doses of statins before PCI.METHODS A total of 752 patients with PCI was selected from 2013 to 2017. The indicators of cTn I,CK-MB,AST,ALT,BUN,sCr before operation and 0-2 h,3-12 h,and 13-24 h after operation,and incidence of MACE during hospitalization were compared among the five groups.(group A: long-term statins therapy+single loading dose of statins before PCI,group B: long-term statins therapy + single dose of statins before PCI,group C: single loading dose of statins before PCI,group D : single doses of statins before PCI,group E: no statins therapy before PCI).RESULTS The elevations of cTn I and CK-MB and the incidence of MACE during hospitalization in group A,B and C were significantly lower than those in group D and E(P<0.05),The values of ALT and AST in the five groups were significantly higher than those before PCI(P<0.05),but were not more than 3 times ULN,The elevations of BUN and sCr in the five groups were not significantly higher than those before PCI(P>0.05).CONCLUSION long-term or single loading dose of statins before PCI can reduce perioperative myocardial injury and the incidence of MACE during hospitalization,and has no effect on liver and kidney function.
OBJECTIVE To investigate the perioperative myocardial protection of statins at a loading dose before percutaneous coronary intervention(PCI),by analyzing the changes of myocardial injury indexes in patients after taking different doses of statins before PCI.METHODS A total of 752 patients with PCI was selected from 2013 to 2017. The indicators of cTn I,CK-MB,AST,ALT,BUN,sCr before operation and 0-2 h,3-12 h,and 13-24 h after operation,and incidence of MACE during hospitalization were compared among the five groups.(group A: long-term statins therapy+single loading dose of statins before PCI,group B: long-term statins therapy + single dose of statins before PCI,group C: single loading dose of statins before PCI,group D : single doses of statins before PCI,group E: no statins therapy before PCI).RESULTS The elevations of cTn I and CK-MB and the incidence of MACE during hospitalization in group A,B and C were significantly lower than those in group D and E(P<0.05),The values of ALT and AST in the five groups were significantly higher than those before PCI(P<0.05),but were not more than 3 times ULN,The elevations of BUN and sCr in the five groups were not significantly higher than those before PCI(P>0.05).CONCLUSION long-term or single loading dose of statins before PCI can reduce perioperative myocardial injury and the incidence of MACE during hospitalization,and has no effect on liver and kidney function.
引文
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[13] Pu GQ.Effect of statins on liver function in patients with acute coronary syndrome [J].Cardiovascu Dis J Integr Tradit Chin Western Med (中西医结合心血管病电子杂志),2017,5(5):19.
[14] Lv JF,Luo WQ,Zhang XM,et al.Effect and safety of different intensity statins on blood lipid level after coronary artery stent implantation in young and middle-aged patients with coronary heart disease [J].J Chongqing Med Univ (重庆医科大学学报),2015,40(4):511-514.
[15] Li JF,Qi SY,Yang XS.Clinical efficacy and safety of intensive atorvastatin treatment in patients with acute coronary syndrome [J].Chin J Evidence-Based Cardiovascu Med (中国循证心血管医学杂志),2015,7(3):326-330.
[16] Patti G,Pasceri V,Colonna G,et al.Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention:results of the ARMYDA-ACS randomized trial [J].J Am Coll Cardiol,2007,49(12):1272-1278.
[2] Han YL.Chinese guidelines for percutaneous coronary intervention (2016) Official release [J].Chin J Interventional Cardiol (中国介入心脏病学杂志),2016,31(6):315-315.
[3] Topol EJ.Intensive statin therapy-a sea change in cardiovascular prevention [J].N Engl J Med,2004,350(15):1562-4.
[4] Qu ZJ,Zhou DY,Su Y,et al.Effects of different doses of statins before PCI on survival of elderly patients with coronary heart disease [J].Chin J Frontiers Med Sci (Electronic Version) (中国医学前沿杂志:电子版),2015,7(9):114-117.
[5] Ge YY,Ma XJ,Lu KF,et al.Effect and mechanism of atorvastatin intensive treatment on PCI in ACS patients [J].Shandong Med J (山东医药),2016,56(37):44-46.
[6] Li N,Ji Z,Wang B,et al.Effects of two doses of atorvastatin on inflammatory factors and MACE in patients with PCI after operation [J].Shandong Med J (山东医药),2017,57(17):50-52.
[7] Xie W,Li P,Wang Z,et al.Rosuvastatin may reduce the incidence of cardiovascular events in patients with acute coronary syndromes receiving percutaneous coronary intervention by suppressing miR‐155/SHIP‐1 signaling pathway [J].Cardiovasc Ther,2014,32(6):276-82.
[8] Huang W.Clinical analysis of hepatic damage caused by statins [J].China Pract Med (中国实用医药),2016,11(12):163-164.
[9] Xu XX,Xu AJ,Xu DZ.Effect of Attovastatin and resuvastatin on liver function in patients with coronary heart disease [J].China Pharm (中国药师),2015(2):255-257.
[10] Liao MH,Liu YG,Zhang GX,et al.Research Progress of Transaminase elevation induced by statins [J].Pharmaceutical J Chin People's Liberat Army (解放军药学学报),2015(2):158-160.
[11] Sun LL,Huang ST.Compliance of statins after PCI in patients with acute coronary syndrome and its effect on prognosis [J].Chin J Integr Med Cardio-Cerebrovasc Dis (中西医结合心脑血管病杂志),2015,13(09):1110-1113.
[12] Cohen DE,Anania FA,Chalasani N.An assessment of statin safety by hepatologists [J].Am J Cardiol,2006,97(8A):77C-81C.
[13] Pu GQ.Effect of statins on liver function in patients with acute coronary syndrome [J].Cardiovascu Dis J Integr Tradit Chin Western Med (中西医结合心血管病电子杂志),2017,5(5):19.
[14] Lv JF,Luo WQ,Zhang XM,et al.Effect and safety of different intensity statins on blood lipid level after coronary artery stent implantation in young and middle-aged patients with coronary heart disease [J].J Chongqing Med Univ (重庆医科大学学报),2015,40(4):511-514.
[15] Li JF,Qi SY,Yang XS.Clinical efficacy and safety of intensive atorvastatin treatment in patients with acute coronary syndrome [J].Chin J Evidence-Based Cardiovascu Med (中国循证心血管医学杂志),2015,7(3):326-330.
[16] Patti G,Pasceri V,Colonna G,et al.Atorvastatin pretreatment improves outcomes in patients with acute coronary syndromes undergoing early percutaneous coronary intervention:results of the ARMYDA-ACS randomized trial [J].J Am Coll Cardiol,2007,49(12):1272-1278.