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论著:他汀类药物对经皮冠状动脉介入治疗患者围手术期心肌损伤的影响
Effect of Statin Therapy Before Percutaneous Coronary Intervention on Periprocedural Myocardial Injury
刘传芬 王伟民 陈红
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作者单位:北京大学人民医院心内科
中文关键字:经皮冠状动脉介入治疗;心肌损伤;他汀
英文关键字:Percutaneous coronary intervention; Myocardial injury; Statin
中文摘要:目的:研究他汀类药物对接受经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)患者围手术期心肌损伤的保护作用。方法:共入选137例择期PCI患者,其中66例他汀组术前口服他汀类降脂药超过7 d,71例(对照组)术前未服用他汀类降脂药。结果:术后他汀组肌钙蛋白I(TnI)及肌酸激酶同功酶MB (CK-MB)峰值的平均值明显低于对照组。两组TnI峰值的平均值分别为0.15±0.23 ng·mL-1和0.48±1.08 ng·mL-1 (P<0.05),CK-MB峰值的平均值分别为2.44±3.05 ng·mL-1和4.98±10.89 ng·mL-1(P<0.05)。术后他汀组和对照组TnI超过正常值上限的发生率分别为24%和48%(P<0.05),超过正常值上限的3倍的发生率分别为12%和25%(P<0.05)。CK-MB超过正常值上限的发生率在他汀组和对照组分别为10%和20%(P<0.05),超过正常值上限的3倍的发生率分别为2%和10%(P<0.05)。Logistic回归分析表明术前服用他汀类药物可减少围手术期心肌损伤(OR=0.42;95%可信区间为0.19~0.92;P=0.03);年龄>65岁是围手术期心肌损伤的重要预测因素(OR=2.4;95%可信区间为1.1~5.23;P=0.03)。结论:PCI术前用他汀1周以上可减少PCI术后的心肌损伤。
英文摘要:Objective: To study the effect of statin in reduction of myocardial injury in patients undergoing percutaneous coronary intervention(PCI).Methods: Total of 137 patients undergoing PCI were included, 66 received statins before PCI, while 71 were not given statins at the time of PCI. Creatine kinase-MB and troponin I were measured at baseline and at 8 and 24 hours after the procedure.Results: Postprocedural peak levels of troponin I (0.15±0.23) versus (0.48±1.08)ng·mL-1, P<0.05, and creatine kinase-MB (2.44±3.05) versus (4.98±10.89) ng·mL-1, P<0.05 were lower in the statin than in the control group. Detection of markers of myocardial injury above the upper normal limit was significantly lower in the statin group versus the control group: 24% versus 48% for troponin I (P<0.05), 10% versus 20% for creatine kinase-MB (P<0.05). Myocardial infarction by troponin I determination was detected after procedure in 12% of patients in the statin group and in 25% of those in the control group (P<0.05).Conclusion: Pretreatment with statin for 7 days significantly reduces procedural myocardial injury in elective PCI.
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