摘要
目的探讨不同剂量阿托伐他汀对急性心肌梗死患者心室重构和血小板活化的影响。方法选取单县中心医院2014年12月至2016年10月收治的急性ST段抬高心肌梗死患者170例为研究对象，采用随机数字表法分为研究组（应用高剂量阿托伐他汀）和对照组（应用低剂量阿托伐他汀），比较两组经皮冠状动脉介入（PCI）术前、术后48h血小板功能指标，术后7d及术后6个月时超声心动图指标改善情况，不良反应及主要心脏不良事件（MACE）发生情况。结果术前两组血小板功能指标差异均无统计学意义（t=0．549、0．376、0．250、0．098，均P〉0．05）。术后48h，研究组平均血小板体积（MPV）、大血小板比例（P-LCR）、外周血血小板（CD62p）、活化GpⅡb／Ⅲa复合物（PAC-1）分别为（12．93±1．74）fL、（29．05±5．79）％、（45．29±5．23）％、（74．53±5．52）％，均低于对照组的（14．21±1．82）fL、（30．94±6．15）％、（48．37±4．82）％、（78．49±5．76）％，差异均有统计学意义（t=4．687、2．063、3．993、4．576，均P〈0．05）；研究组心肌灌注分级（TMPG）良好62例（72．94％），对照组良好49例（57．64％），两组TMPG良好率差异有统计学意义（x2=4．387，P〈0．05）。术后7d，两组超声心动图指标差异均无统计学意义（t=0．160、0．467、0．448、0．745，均P〉0．05）。术后6个月，研究组左室射血分数（LVEF）[（50．1J±3．79）％]较对照组高[（48．45±4．10）％]，左室舒张末期容积（LVEDV）[（110．13±8．83）mL]、左室收缩末期内径（LVESV）[（60．18±6．07）mL]、左心室质量（LVMI）[（101．52±4．33）g／m2]均较对照组低[（112．84±8．46）mL、（63．51±5．51）mL、（103．94±4．19）s／m2]，差异均有统计学意义（t=2．043、3．745、3．703、2．741，均P〈0．05）。两组肝损害与肌病发生率差异均无统计学意义（x2=0．525、0．000，均P〉0．05）。研究组发生MACE事件6例，对照组发生MACE事件16例，Kaplan—Meier生存分析提示研究组累积无MACE事件生存率（92．94％）较对照组高（81．17％），差异有统计学意义（Logrank=0．411，P〈0．05）。结论高剂量阿托伐他汀可有效改善急性sT段抬高心肌梗死患者血小板活化及心室重构，预后及安全性良好。
Objective To investigate the influence of different dose of atorvastatin on ventrieular remodeling and platelet activation in patients with acute myocardial infarction（AMI）. Methods From December 2014 to October 2016,170 patients with acute ST segment elevation myocardial infarction in the Central Hospital of Shah County were chosen and randomly divided into control group （low dose atorvastatin） and research group （high dose atirvastatin）. The platelet index before operation and 48h after operation, echocardiographic index 7d after operation and 6 months after operation, adverse reaction and major adverse cardiac events （MACE） were compared between the two groups. Results Before operation, the platelet index between the two groups had no statistically significant differences （t = 0. 549,0. 376,0. 250,0. 098, all P 〉 0.05 ）. At 48 h alter operation, the mean platelet volume （ MPV）, platelet - large ratio （ P - LCR） , peripheral blood platelet （CD62p） , activation of Gp IIb/IIIa complex （ PAC - 1 ） of the research group were （ 12.93 ± 1.74） fL, （ 29.05 ± 5.79 ） % , （45.29 ± 5.23 ） % , （ 74.53 ± 5.52 ） %, which were lower than those of the control group [ （ 14.21 ± 1.82 ） fL, （ 30.94 ±6. 15 ） %, （,48.37 ± 4.82 ） %, （ 78.49 ± 5.76 ） % ], the differences were statistically significant （t = 4.687,2. 063,3.993,4.576, all P 〈 0.05 ）. In the research group, 62 cases （72.94%） were TMPG good,49 cases（57.64% ） in the control group,the difference between two groups was statisti-cally significant （x2 = 4. 387, P 〉 0.05 ）. Echocardiographic indicators 7d after operation between the two groups had no statistically significant differences （ t = 0.160 ,0. 467 ,0. 448,0. 745, all P 〉 0.05 ）. Six months after operation, the left ventricular ejection fraction （ LVEF ） of the research group [ （ 50. 11 ± 3.79 ） % ] was higher than that of the control group [ （48.45 ± 4.10 ）% ] , the left ventricular end diastolic volume （LVEDV） [ （110.13 ± 8.83 ）mL ] , left ventricular end systolic diameter （LVESV） [ （60.18 ± 6.07 ）mL], left ventricular mass index （LVMI） [ （101.52 ± 4.33 ） g/m2 ] of the research group were lower than those of the control group [ （ 112.84 ± 8.46 ） mL, （ 63.51 ± 5.51 ） mL, （ 103.94 ± 4.19 ） g/m2 ], the differences were statistically significant （ t = 2.043,3. 745,3. 703,2. 741, all P 〈 0.05 ）. The incidence rate of liver damage and myopathy between the two groups had no statistically significant difference（x2 =0. 525,0.000,all P 〉0.05）. There were 6 cases of MACE occurred in the research group, 16 cases occurred in the control group, Kaplan - Meier survival analysis showed cumulative non MACE event survival rate of the research group（92.94% ） was higher than that of the control group（ 81.17% ）, the difference was statistically significant （Logrank = 0. 411, P 〈 0.05 ）. Conclusion High atorvastatin dose can better improve the platelet and ventricular remodeling, and with good safety and. prognosis.
作者
许永梅
Xu Yongmei(Department of Cardiology,the Central Hospital of Shah County,Shandong 274300,Chin)
出处
《中国基层医药》
CAS
2018年第14期1824-1828,共5页
Chinese Journal of Primary Medicine and Pharmacy
关键词
心肌梗死
血小板
心室重构
血小板活化
阿托伐他汀
Myocardial infarction
Platelet
Ventricular remodeling
Platelet activation
Atorvastatin
