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目的比较不同负荷剂量他汀类药物对老年急性ST段抬高型心肌梗死(STEMI)直接PCI术后心肌的影响。方法老年STEMI行直接PCI患者120例,随机分4组,每组30例,阿托伐负荷组(80mg),阿托伐常规组(20mg),瑞舒伐负荷组(20mg),瑞舒伐常规组(5mg),分别检测PCI术前和术后2h炎性、氧化活性和纤溶活性指标。比较术后ST段回落指数(STR)、校正TIMI帧计数(CTFC)、30d心脏彩色超声和主要心脏不良事件(MACE)。结果阿托伐负荷组与阿托伐常规组、瑞舒伐负荷组与瑞舒伐常规组术后2h炎性、氧化活性和纤溶活性指标比较有显著差异(P<0.05)。阿托伐负荷组与阿托伐常规组、瑞舒伐负荷组与瑞舒伐常规组CTFC[(15.2±4.6)帧vs(21.7±5.2)帧,(15.6±4.2)帧vs(22.9±5.9)帧]和STR≥50%(93.3%vs 46.7%,86.7%vs43.3%)比较有显著差异(P<0.05)。2个负荷组30dLVEF和MACE均好于2个常规组(P<0.05),2个负荷组上述各项比较无显著差异(P>0.05)。结论老年STEMI行直接PCI术前用负荷剂量他汀类药物,可降低氧化应激,减少心肌细胞坏死,改善短期预后,阿托伐他汀与瑞舒伐他汀无显著差异。
Objective To compare the effects of different loading doses of statins on myocardial infarction in elderly patients with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 120 elderly patients undergoing STEMI with direct PCI were randomly divided into 4 groups (n = 30 each), atorvastatin group (80mg), atorvastatin group (20mg), rosuvastatin group The conventional group (5mg), respectively, before and after PCI 2h inflammatory, oxidative activity and fibrinolytic activity indicators. Postoperative ST-segment fall index (STR), corrected TIMI frame count (CTFC), 30-day cardiac color echocardiography and major cardiac adverse events (MACE) were compared. Results The indexes of inflammatory, oxidative activity and fibrinolytic activity in atorvastatin group, routine group, rosuvastatin group and rosuvastatin group at 2 hours after operation were significantly different (P <0.05). Atorvastatin group and atorvastatin group had significant differences compared with CTFC [(15.2 ± 4.6) vs (21.7 ± 5.2) and (15.6 ± 4.2) vs (22.9 ± 5.9) ) Frame] and STR≥50% (93.3% vs 46.7%, 86.7% vs43.3%) (P <0.05). The 30dLVEF and MACE in 2 load groups were better than those in 2 normal groups (P <0.05). There was no significant difference between the 2 load groups (P> 0.05). Conclusion STEMI in elderly patients undergoing direct PCI before loading with statins can reduce oxidative stress, reduce myocardial necrosis and improve short-term prognosis, atorvastatin and rosuvastatin no significant difference.