| Objective:This study aims to investigate the myocardial protection from a atorvastatin intensive treatment before PCI in patients with ACS, the correlation between the protection and the changes of blood ET-1,NO,FG,PAI-llevels.Methods:This study collects 113 cases of ACS patients who intend to undergo percutaneous coronary intervention in our cardiology department, who are randomly divided into three groups: 35 patients comprising the standard treatment group(Atorvastatin 20mg/d),44 patients comprising the enhanced 1 group(given atorvastatin 40mg,20mg separately at preoperative 12h, 2h on the basis of standard treatment).34 patients comprising the enhanced 2 group(given atorvastatin 80mg,40mg separately at preoperative 12h,2h on the basis of standard treatment). All patients keep the treatment(taking atorvastatin 20mg,QN)after PCI. We record their general clinical information,such as:age,sex,the history of diabetes,hypertention,etc. The test attempts to detect the following information:(1)the CK-MB,cTnI,ET-1,NO,FG,PAI-1 levels at preoperative 1 day,postoperative 6h,postoperative 12h; (2)the TC,LDL-C,ALT value at preoperative 1 day,postoperative 3d,postoperative 30d.The methods of main index' determination:ET-1:Double antibody sandwich ELISA;NO:Nitrate reductase enzymatic assay;PAI-1:Double antibody sandwich ELISA. We detece the remaining parameters independently in our own biochemistry laboratory. All data were analyzed and compared by SPSS 16.0.Results (1)Among them,29cases of the standard treatment group,36 cases of the enhanced 1 group and 28 cases of the enhanced 2 group are finally undergoing the test.(2)The general clinical information among three groups are comparable. (3)The values of CK-MB,cTnI,ET-1,NO,FG,PAI-1:There is no significant difference of them among the three groups at preoperative 1 day(p> 0.05); The values of ET-1,FG,PAI-1 markedly increase at postoperative 6h,12h and the difference is statistically significant(p<0.05); The values of the standard treatment group is markedly higher at postoperative 12h than 6h[ET-1:(194.2±12.8) ng/L vs(154.6±13.4)ng/L;FG:(428±107) mg/dLvs(376±112)mg/dL;PAI-1:(71.5±50.6) ug/Lvs(62.8±45.9)ug/L;CK-MB:(4.36±2.71)ng/mlvs(2.87±1.65)ng/ml;cTnI:(0.36±0.21)ng/mlvs(0.25±0.12)ng/ml](P<0.05). The values of NO markedly decrease at postoperative 6h,12h and the difference is statistically significant(p<0.05); The values of the standard treatment group is markedly lower at postoperative 12h than 6h [NO:(35.2±12.4) umol/Lvs (41.3±11.4) umol/L]. The values of CK-MB,cTnI,ET-1,FG,PAI-1 with the enhanced 1,2 group is higher at postoperative 12h than at postoperative 6h, however, the difference is statistically insignificant(p>0.05); At postoperative 6h:There is no significant difference of them among the three groups(p>0.05); At postoperative 12h:the values of enhanced groups CK-MB,cTnI,ET-1,FG,PAI-1 are less than the standard treatment group and the values of enhanced groups NO are long than the standard treatment group,and the difference is statistically significant(p<0.05); There is a correlation among CK-MB,cTnI,ET-1,NO,FG,PAI-1. (4) There is no significant difference about TC,LDL-C,ALT,Scr among the three groups at preoperative 1 day(p>0.05), and the values of them are within their normal range. TC,LDL-C have no markedly changes at postoperative 3d, but all drop down at postoperative 30d(p<0.05); ALT,Scr change in varying degrees at postoperative 3d,30d than preoperative 1 day(p>0.05), the maximum value of ALT are also within 2ULN (They all returned normal levels after one week, and the patients have no obvious discomfort, so they continue to take the tablets.Conclusions(1)It will restrain the values of CK-MB,cTnI levels in patients with ACS who had a high dose atorvastatin intensive treatment before PCI.Then reduce the incident of myocardial infaction. (2)Short-term intensive therapy of atorvastatin can reduce the ET-1,FG,PAI-1 levels and raise the NO effectively. (3)There has a positive correlation among CK-MB,cTnI with ET-1,FG,PAI-1. but also have a negative correlation with NO, It prompts that endothelial disorder and fibrinolytic activation may take part in the myocardial infaction process after PCI. Short-term intensive therapy of atorvastatin is conducive to protecting the endothelial function and recovering the unbalance state between blood coagulation and fibrinolytic system.making further protection in myocardium, and perhaps the protective effects and lipid lowing are mutually independent.(4)The measures come from short-term intensive therapy of atorvastatin are safety. Therefore,It can be used as an early administration to prevent myocardial infarction at perioperative.
|
PDF Full Text Request