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目的:探讨不同剂量阿托伐他汀对急性心肌梗死(AMI)患者行冠状动脉介入治疗(PCI)后相关指标及主要不良心血管事件(MACE)的影响。方法:120例AMI并成功施行PCI患者随机分为常规剂量组(60例)和大剂量组(60例)。两组患者确诊后均立即给予低分子肝素、阿司匹林肠溶片、硫酸氢氯吡格雷片、血管紧张素转换酶抑制剂、β受体阻滞药、硝酸酯类药物等常规治疗。在此基础上,常规剂量组患者给予阿托伐他汀钙片20 mg,每日睡前口服1次;大剂量组患者给予阿托伐他汀钙片40 mg,每日睡前口服1次。两组疗程均为1个月。观察两组患者治疗前后总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、C反应蛋白(CRP)、血浆可溶性OX40配体(OX40L)、白细胞介素6(IL-6)水平,分析OX40L与CRP及IL-6的相关性,术后随访1个月记录两组患者MACE发生情况。结果:治疗前,两组患者TG、TC、LDL-C、HDL-C、CRP、OX40L、IL-6水平比较,差异均无统计学意义(P>0.05)。治疗后,TG、TC、LDL-C、CRP、OX40L、IL-6水平均显著低于同组治疗前,且大剂量组TC、LDL-C、CRP、OX40L、IL-6水平低于常规剂量组,HDL-C水平均显著高于同组治疗前,差异均有统计学意义(P<0.01或P<0.05),但两组TG、HDL-C水平比较差异均无统计学意义(P>0.05)。治疗前,两组患者OX40L与CRP(r=0.746,P<0.01)、IL-6(r=0.763,P<0.01)均呈正相关;治疗后,两组患者OX40L与CRP(r=0.755,P<0.01)、IL-6(r=0.760,P<0.01)亦呈正相关。大剂量组患者MACE发生率显著低于常规剂量组,差异有统计学意义(P<0.05)。结论:在常规治疗的基础上,阿托伐他汀可显著降低患者血脂、炎症水平、MACE发生率,但大剂量时效果更加显著。
OBJECTIVE: To investigate the effects of atorvastatin with different doses on related indicators and major adverse cardiovascular events (MACE) in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI). METHODS: 120 patients with AMI after PCI were randomly divided into conventional dose group (60 cases) and high dose group(60 cases). All patients were immediately given low molecular weight heparin, Aspirin enteric-coated tablet, Clopidogrel bisulfate tablet, Angiotensin-converting enzyme inhibitor, β-blockers, nitrates and other conventional treatment; based on it, conventional dose group was given 20 mg Atorvastatin calcium tablet, once every day before bedtime; high dose group was given 40 mg Atorvastatin calcium tablet, once every day before bedtime. The treatment course for both groups was 1 month. Total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), C-reactive protein (CRP), OX40L, interleukin (IL)-6 levels in 2 groups before and after treatment were observed, the correlation among OX40L with CRP and IL-6 were analyzed, and the incidence of MACE in 2 groups was recorded after 1 month follow-up. RESULTS: Before treatment, there were no significant differences in the TG, TC, LDL-C, HDL-C, OX40L, CRP and IL-6 between 2 groups (P>0.05). After treatment, TG, TC, LDL-C, OX40L, CRP and IL-6 were aignificantly lower than before, TC, LDL-C, OX40L, CRP and IL-6 in high dose group were lower than conventional dose group, HDL-C was significantly higher than before, the differences were statistically significant (P<0.01 or P<0.05); but there was no significant difference in the HDL-C between 2 groups (P>0.05). Before treatment, OX40L showed positive correlation with CRP (r=0.746, P<0.01) and IL-6 (r=0.763, P<0.01); after treatment, OX40L also showed positive correlation with CRP (r=0.755, P<0.01) and IL-6 (r=0.760, P<0.01). The incidence of MACE in high dose group were significantly lower than conventional dose group, the difference was statistically significant(P<0.05). CONCLUSIONS: Based on the conventional treatment, atorvastatin can significantly reduce lipid, inflammation levels and incidence of MACE, but the effect is more significant in high dose.
急性心肌梗死冠状动脉介入治疗阿托伐他汀主要不良心血管事件
Acute myocardial infarctionPercutaneous coronary interventionatorvastatinMajor adverse cardiovascular events
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