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目的探讨瑞舒伐他汀对预防冠脉介入术后再狭窄的临床疗效及其作用机制。方法将2010年5月～2011年5月心血管内科进行冠脉介入治疗的120例心肌梗死患者随机分为瑞舒伐他汀组和对照组,每组各60例。两组患者均于介入手术治疗前常规口服氯吡格雷300mg、阿司匹林300mg,术后注射低分子肝素钙3～7d,口服阿司匹林100mg/d、氯吡格雷75mg/d,同时两组均常规使用硝酸酯类。瑞伐他汀组在常规治疗的基础上加服瑞伐他汀10mg,每日1次,疗程为6个月。治疗后6个月进行冠状动脉造影复查,比较两组介入术后再狭窄率。采用酶联免疫法测定血清白细胞介素-6(IL-6)和血浆超敏C-反应蛋白(hs-CRP)水平,采用硝酸还原酶法测定一氧化氮(NO),采用放射免疫法测定内皮素-1(ET-1)。入院时和术后6个月分别检测一次。结果 (1)治疗后复查冠脉造影,瑞舒伐他汀组再狭窄率为3.33%(2例),对照组为13.33%(8例),两组相比差异有统计学意义(P﹤0.05)。(2)治疗前,瑞伐他汀组和对照组IL-6,hs-CRP,NO和ET-1水平分别为(14.2±6.8vs13.9±7.0pg/ml),(6.2±1.5vs6.1±1.7mg/L),(48.1±15.8vs47.8±16.0μmol/L)和(82.0±9.1vs82.1±8.9ng/L);治疗后,瑞伐他汀组和对照组IL-6,hs-CRP,NO和ET-1水平分别为(6.8±2.5vs9.2±3.6pg/ml),(4.1±1.2vs5.8±1.7mg/L),(63.2±17.6vs47.6±15.9μmol/L)和(61.6±9.5vs80.5±9.3ng/L);瑞伐他汀组治疗后IL-6,hs-CRP,NO和ET-1水平与治疗前以及对照组治疗后比较差异均有统计学意义(P﹤0.05)。结论瑞舒伐他汀对防治冠脉介入术后再狭窄有一定的作用,其作用机制可能与抑制介入术后炎性反应,改善血管内皮功能有关。
Objective To investigate the clinical effect of rosuvastatin on restenosis after percutaneous coronary intervention and its mechanism. Methods 120 patients with myocardial infarction underwent coronary intervention from May 2010 to May 2011 were randomly divided into rosuvastatin group and control group, 60 cases in each group. Both groups were given routine oral clopidogrel 300mg, aspirin 300mg, postoperative injection of low molecular weight heparin 3-7d, oral aspirin 100mg / d, clopidogrel 75mg / d, while the two groups were routinely used nitric acid Esters. In the treatment group, 10 mg of revastatin was given once a day for 6 months on the basis of routine treatment. Coronary angiography was performed 6 months after treatment, and the rate of restenosis was compared between the two groups. Serum levels of interleukin-6 (IL-6) and plasma hs-CRP were measured by enzyme-linked immunosorbent assay. Nitric oxide (NO) was measured by nitrate reductase method and radioimmunoassay Endothelin-1 (ET-1). At admission and 6 months after surgery were tested once. Results (1) After coronary angiography, the restenosis rate in rosuvastatin group was 3.33% (2 cases) and in control group was 13.33% (8 cases), the difference was statistically significant (P <0.05 ). (2) Before treatment, the levels of IL-6, hs-CRP, NO and ET-1 in the CHF group and the control group were (14.2 ± 6.8 vs13.9 ± 7.0pg / ml), (6.2 ± 1.5vs6.1 ± 1.7mg / L), (48.1 ± 15.8vs47.8 ± 16.0μmol / L) and (82.0 ± 9.1vs82.1 ± 8.9ng / L), respectively. After treatment, The levels of -CRP, NO and ET-1 were (6.8 ± 2.5 vs 9.2 ± 3.6 pg / ml), (4.1 ± 1.2 vs 5.8 ± 1.7 mg / L), (63.2 ± 17.6 vs 47.6 ± 15.9 μmol / L and 61.6 ± 9.5vs80.5 ± 9.3ng / L, respectively. The levels of IL-6, hs-CRP, NO and ET-1 in the treatment group were significantly lower than those in the control group Significance (P <0.05). Conclusion Rosuvastatin may play a certain role in the prevention and treatment of restenosis after coronary intervention. Its mechanism may be related to inhibiting inflammatory reaction and improving endothelial function after PCI.