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目的探讨急性ST段抬高性心肌梗死(STEMI)患者在接受急诊经皮冠状动脉介入手术(PCI)前口服阿托伐他汀40 mg,对外周静脉和梗死相关冠状动脉(ICA)中的炎症介质水平与左心室功能的影响。方法选取接受急诊PCI的STEMI患者60例,随机分为治疗组(PCI术前口服阿托伐他汀40 mg,n=32)和对照组(n=28)。两组分别于PCI术前即刻、术后24 h抽取外周静脉血和术中抽取ICA血,测定并比较白细胞介素-6(IL-6)、基质金属蛋白酶-9(MMP-9)和可溶性CD40配体(sCD40L)的浓度;PCI术后1周常规行超声心动图检查,测定左心室舒张末期容积(EDV-LV)、左心室收缩末期容积(ESV-LV)、左心室射血分数(LVEF)、左心室峰值射血率(PER-LV)、左心室峰值充盈率(PFR-LV)。结果组间对比,PCI术前,治疗组外周静脉中IL-6的浓度显著低于对照组;PCI术后24 h,治疗组外周静脉血中的IL-6、sCD40L和MMP-9浓度显著低于对照组。AMI后第7天,治疗组的EDV-LV、ESV-LV、LVEF、PER-LV、PFR-LV较对照组无显著变化;组内对比,在两组患者中,PCI术前ICA中的IL-6s、CD40L和MMP-9浓度均显著高于其外周静脉水平。术后24 h,所有患者外周静脉血IL-6和MMP-9的浓度均显著增高(P均<0.05),而sCD40L的浓度只有对照组明显升高(P均<0.05)。结论STEMI发生时,ICA中的MMP-9I、L-6和sCD40L的水平显著高于外周静脉,而患者于急诊PCI术前口服阿托伐他汀能够不同程度降低炎症介质的水平,但对近期左心室功能无明显改善。
Objective To investigate the effects of atorvastatin 40 mg on peripheral venous and infarct-related coronary arteries (ICA) in patients with acute ST-elevation myocardial infarction (STEMI) before oral percutaneous coronary intervention (PCI) Level and left ventricular function. Methods Sixty STEMI patients undergoing emergency PCI were randomly divided into treatment group (40 mg oral atorvastatin, n = 32) and control group (n = 28). Peripheral venous blood was drawn 24 h after PCI and ICA blood was collected immediately before PCI, and IL-6, MMP-9 and soluble CD40 ligand (sCD40L) concentration; 1 week after PCI routine echocardiography, left ventricular end diastolic volume (EDV-LV), left ventricular end systolic volume (ESV-LV), left ventricular ejection fraction LVEF), left ventricular ejection rate (PER-LV) and left ventricular peak filling rate (PFR-LV). Results Before and after PCI, the concentration of IL-6 in the peripheral vein of the treatment group was significantly lower than that of the control group. At 24 h after PCI, the concentrations of IL-6, sCD40L and MMP-9 in the peripheral venous blood of the treatment group were significantly lower In the control group. On the 7th day after AMI, the EDV-LV, ESV-LV, LVEF, PER-LV and PFR-LV in the treatment group had no significant change compared with the control group. In the two groups, -6s, CD40L and MMP-9 concentrations were significantly higher than the peripheral vein level. The concentrations of IL-6 and MMP-9 in peripheral venous blood of all patients were significantly increased at 24 h after operation (all P <0.05), while the concentrations of sCD40L in control group were significantly increased only (all P <0.05). Conclusions The levels of MMP-9I, L-6 and sCD40L in ICA are significantly higher than those in peripheral vein in patients with STEMI, and atorvastatin in patients before emergency PCI can reduce the levels of inflammatory mediators to some extent. However, No significant improvement in ventricular function.