本文選題：他汀 + 急性ST段抬高型心肌梗死��； 參考：《復(fù)旦大學(xué)》2014年博士論文

【摘要】：背景：他汀具有獨立于降脂功能的多效性作用,它可能通過其抗炎效應(yīng)減輕患者經(jīng)皮冠狀動脈介入治療(PCI)術(shù)后冠狀動脈微栓塞,進(jìn)而改善患者遠(yuǎn)期心肌重構(gòu)和臨床預(yù)后。本研究旨在探討直接PCI術(shù)前單次應(yīng)用負(fù)荷劑量瑞舒伐他汀強化治療能否改善急性ST段抬高型(STEMI)心肌梗死患者的術(shù)后炎性反應(yīng)和心肌重構(gòu)。方法：49位被診斷為STEMI、梗死相關(guān)動脈為左前降支的患者被分入他汀組(n=10,59±13歲,90%男性)和對照組(n=39,61±12歲,82%男性),分別在直接PCI術(shù)前一次性給予瑞舒伐他汀40mg負(fù)荷劑量或不給予他汀類藥物治療,所有患者在術(shù)后接受瑞舒伐他汀常規(guī)劑量10mg/d治療。主要終點為直接PCI術(shù)后30天主要不良心血管事件(MACE)發(fā)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運重建,次要終點為術(shù)后12個月MACE發(fā)生率。在直接PCI術(shù)前、術(shù)后12h、36h和60h分別檢測所有患者的血清肌酸激酶-MB亞型(CK-MB)、肌鈣蛋白T(cTnT)、單核細(xì)胞趨化蛋白-1(MCP-1)、基質(zhì)金屬蛋白酶-9(MMP-9)、基質(zhì)金屬蛋白酶抑制因子-1(TIMP-1)和骨橋蛋白(OPN)濃度。所有患者在直接PCI術(shù)后1周和12個月接受超聲心動圖檢查。結(jié)果：兩組患者的基線臨床特征沒有顯著性差異。直接PCI術(shù)后30天對照組患者M(jìn)ACE發(fā)生率5.1%,他汀組未發(fā)生MACE,不具有統(tǒng)計學(xué)差異。兩組患者CK-MB和cTnT峰值及各個時間點的濃度均無顯著性差異。兩組患者在直接PCI術(shù)前的血清MCP-1濃度、MMP-9/TIMP-1比值無顯著差異,但他汀組患者的MCP-1水平在術(shù)后36h (5.87±14.47 vs.86.25±23.02 pg/ml, p0.001)及術(shù)后60h (62.34±13.11 vs.85.33±23.21pg/ml, p=0.01)明顯低于對照組,MMP-9/TIMP-1比值在術(shù)后60h與對照組相比顯著降低(35.15±9.14 vs.45.67±9.76,p=0.009)。兩組患者的血清OPN濃度在各個時間點無顯著性差異。兩組患者在直接PCI術(shù)后1周的左室射血分?jǐn)?shù)(LVEF)、左室舒張末期容積(LVEDV)和左室收縮末期容積(IVESV)無顯著性差異。結(jié)論：STEM1患者直接PCI術(shù)前給予單次負(fù)荷劑量瑞舒伐他汀強化治療,對改善術(shù)后30天MACE發(fā)生率未得到顯著性差異,但可以抑制術(shù)后炎性反應(yīng)并在一定程度上改善心肌重構(gòu)。
[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 鹵13 years old, 90% male) and control group (39 61 鹵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 鹵14.47 vs.86.25 鹵23.02 PG / ml) and 60 h after operation (62.34 鹵13.11 vs.85.33 鹵23.21pg / ml, p0.01), which was significantly lower than that in the control group at 60h after operation (35.15 鹵9.14 vs.45.67 鹵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.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2014
【分類號】：R542.22

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