2017 年第 10 期 第 12 卷

阿托伐他汀负荷量加高维持量对急性冠状动脉综合征患者血管内皮功能及心功能的影响

Effects of loading dose plus high maintenance dose of atorvastatin on vascular endothelial function and cardiac function in patients with acute coronary syndrome

作者：张亮黄文胜冷利华

英文作者：Zhang Liang Huang Wensheng Leng Lihua

单位：246003海军安庆医院心血管内科

英文单位：Department of Cardiovascular Medicine the PLA Navy Anqing Hospital Anhui Province Anqing 246003 China

关键词：急性冠状动脉综合征；阿托伐他汀；血管内皮功能

英文关键词：Acutecoronarysyndrome;Atorvastatin;Vascularendothelialfunction

• 摘要：

• 目的 探讨阿托伐他汀负荷量加高维持量对急性冠状动脉综合征(ACS)患者血管内皮功能及心功能的影响。方法 收集2016年3月至2017年3月海军安庆医院收治的118例ACS患者的临床资料，患者均实施经皮冠状动脉介入（PCI）治疗；依据患者PCI围术期用药方式差异分为观察组与对照组，各59例。观察组采取阿托伐他汀负荷量加高维持量用药，对照组采用常规阿托伐他汀剂量用药，对比2组治疗后生化指标、血管内皮功能及心功能指标情况。结果 出院1个月复查结果显示，观察组总胆固醇、三酰甘油、低密度脂蛋白胆固醇均明显低于对照组，高密度脂蛋白胆固醇明显高于对照组，差异均有统计学意义（均P＜0.05）；观察组肌酸激酶、肌酸激酶同工酶、α羟丁酸脱氢酶、乳酸脱氢酶等心肌酶学指标以及高敏C反应蛋白水平均明显低于对照组，差异均有统计学意义（均P＜0.05）。观察组内皮素1、血管性假血友病因子水平明显低于对照组，一氧化氮水平明显高于对照组，差异均有统计学意义［（54±6）ng/L比（67±7）ng/L、（92±8）%比（106±10）%、（78±8）μmol/L比（67±7）μmol/L］（均P＜0.05）。观察组左心室射血分数、二尖瓣舒张早期与舒张晚期血流速度峰值比值明显高于对照组，心功能收缩、舒张指数及心肌做功指数均明显低于对照组，差异均有统计学意义［（63±8）%比（58±7）%、（1.28±0.21）比（1.04±0.17）、（0.22±0.03）比（0.28±0.05）、（0.24±0.04）比（0.31±0.06）、（0.41±0.07）比（0.53±0.08）］（均P＜0.05）。结论 ACS患者实施阿托伐他汀负荷量加高维持量治疗，可改善患者PCI治疗效果，降低心肌受损程度，减少血管内皮细胞功能的损伤，促进心功能改善。

• Objective To explore effects of loading dose plus high maintenance dose of atorvastatin on vascular endothelial function and cardiac function in patients with acute coronary syndrome（ACS）. Methods Clinical data of 118 patients with ACS who had percutaneous coronary intervention (PCI) from March 2016 to March 2017 in the PLA Navy Anqing Hospital were retrospectively analyzed. The observation group（59 cases） had loading dose plus high maintenance dose of atorvastatin and the control group（59 cases） had routine administration method of atorvastatin during perioperative period of PCI. Biochemical indicators, vascular endothelial function and cardiac function indexes were analyzed. Results One month after discharge, levels of total cholesterol, triacylglycerol, low-density lipoprotein cholesterol in observation group were significantly lower and the level of high-density lipoprotein cholesterol was significantly higher than those in control group（P＜0.05）; levels of creatine kinase, creatine kinase isoenzyme, α-hydroxybutyric dehydrogenase, lactate dehydrogenase and high-sensitivity C-reactive protein in observation group were significantly lower than those in control group（P＜0.05）; levels of endothelin-1, von Willebrand factor were significantly lower and nitric oxide was significantly higher than those in control group［（54±6）ng/L vs （67±7）ng/L, （92±8）% vs （106±10）%, （78±8）μmol/L vs （67±7）μmol/L］（P＜0.05）; left ventricular ejection fraction, mitral valve early diastolic blood flow peak velocity/late diastolic blood flow peak velocity ratio in observation group were significantly higher and cardiac function systolic index, diastolic index, myocardial performance index（Tei index） were significantly lower than those in control group［（63±8）% vs （58±7）%,（1.28±0.21） vs （1.04±0.17）, （0.22±0.03） vs （0.28±0.05）,（0.24±0.04） vs （0.31±0.06）,（0.41±0.07） vs （0.53±0.08）］（P＜0.05）. Conclusion Loading dose plus high maintenance dose of atorvastatin treating patients with ACS can improve cardiac and vascular endothelial function.