The Changes And The Relativity Study On Postoperative Myocardial Injury Markers And Blood Hs-CRP,TNF-α,P-selectin Levels From PCI Preoperative Load Statins In Patients With Acute Coronary Syndrome

Objective This research investigates,before Percutaneous Coronary Intervention(PCI), the protective action to myocardium from different doses atorvastatin intensivetreatment in patients with ACS, the relativity between the protection and the changesof blood hs-CRP,TNF-α,P-selectin levels.Methods This research collects 113 ACS sufferers who intend to undergo PCI in ourcardiology department, who are randomly divided into three groups: Group I is thestandard treatment group, consisting of 35 patients treated 20mg atorvastatin. GroupII is the enhanced 1 group, consisting of 44 patients treated more atorvastatin 40mg,20mg separately at preoperative 12h, 2h on the basis of standard treatment. Group IIIis the enhanced 2 group, consisting 34 patients given more atorvastatin 80mg, 40mgseparately at preoperative 12h, 2h on the basis of standard treatment. All patients willmaintain the treatment(taking atorvastatin 20mg,QN)after PCI. All patients'generalclinical information like age,gender and medical history of diabetes andhypertention,etc. are recorded. Observation:⑴The CK-MB,cTnI,hs-CRP,TNF-αand P-selectin levels at preoperative 1 day,postoperative 6h,postoperative 12h;⑵The TC,LDL-C and ALT levels at preoperative 1 day,postoperative 3d,postoperative 30d;⑶The abnormal incidence of major cardiovascular envents withinpostoperative 30d, which includes perioperative myocardial injury,recurrent MI andTVR. The methods of main indicators measurement: hs-CRP: Latex enhancedimmunoturbidimetric assay; TNF-α: Radioimmunoassay; P-selectin: Enzyme-linkedimmunosorbent assay. Other parameters will work out independently in ourbiochemistry laboratory. All datas were analyzed and compared through SPSS 16.0statistical software.Results⑴29 patients from Group I, 36 patients from Group II, and 28 patients fromGroup III are successfully passed the test.⑵The general clinical information amongthe three groups are comparable.⑶The levels of CK-MB,cTnI,hs-CRP,TNF-αand P-selectin: There is no significant difference of them among the three groups atpreoperative 1 day(p＞0.05); However, The difference markedly increase atpostoperative 6h,12h(p＜0.05); In Group I, The difference at postoperative 12h ismarkedly higher than the deference at postoperative 6h. [hs-CRP:(13.42±4.89)mg/Lvs(9.37±4.19)mg/L; TNF-α:(1.44±0.19)ng/mlvs(1.31±0.17)ng/ml; P-selectin:(3.70±0.12)×103pg/mlvs(0.53±0.06)×103pg/ml;CK-MB:(4.36±2.71)ng/mlvs(2.87±1.65)ng/ml; cTnI: (0.39±0.19)ng/mlvs(0.25±0.12)ng/ml](P＜0.05). In Group II andGroup III, the difference at postoperative 12h is comparatively higher than thedefference at postoperative 6h, but has no statistical values(p＞0.05). At postoperative6h: The difference is unconspicuous among the three groups (p＞0.05); Atpostoperative 12h: the difference in Goup II and Group III are lower than thedifference in Group I, and the difference is statistically remarkable(p＜0.05);Moreover, there is of positive relativity among CK-MB,cTnI and hs-CRP,TNF-α,P-selectin. The difference between Group I and Group II is unconspicuous, and has nostatistical value (P＞0.05). (4) There is no significant difference about TC,LDL-C,ALT,Scr among the three groups in preoperative 1 day(p＞0.05), and the levels ofthem are at normal. TC,LDL-C have no markedly changes in postoperative 3d, but alldecreased obviously in postoperative 30d(p＜0.05); In postoperative 3d,30d, ALT,Scr fluctuated in varying degrees. than preoperative 1 day(p＞0.05), the highestrecord of ALT are also within 2ULN(One week later, ALT and Scr are back tonormal level), and the patients have no obvious discomfort, so they keep takingtablets.⑸There are separately 11cases,8 cases,6 cases patients who sufferingmyocardial injury among three groups, recurrent MI 1,0,0 cases,TVR 1,0,0 cases.The enhanced treatment groups are lower than that of the standard treatmentgroup.But there is no significant difference(p＞0.05).Conclusion⑴It has positive effects, will restrain the values of CK-MB,cTnI levelsin patients with ACS who had a high dose atorvastatin intensive treatment beforePCI.⑵Short-term intensive therapy of atorvastatin can decrease the levels of hs-CRP,TNF-α,P-selectin effectively. Which contributes to recover the imbalance betweenproinflammatory and anti-inflammatory.⑶There has a positive relativity amongCK-MB,cTnI and hs-CRP,TNF-α,P-selectin. It implied that inflammatory andplatelet activation partcipate the process of myocardial infaction caused by PCI. Wefind that the parameters blood lipid have no parallel changes, perhaps the protectiveeffects and lipid lowing are mutually independent.⑷The incidence of mydiovascular events have a decreasing trend according to one-month-follow-up-visit. Perhapsshort-term intensive therapy of atorvastatin can reduce the occurrence ofmydiovascular events.⑸The measures come from short-term intensive therapy ofatorvastatin are safety. Therefore, It can be used as an early stage administration toprevent myocardial injury at perioperative and improve the prognosis.