| In recent years,the technology of percutaneous coronary intervention developes rapidly andbecomes more mature. However PCI is always associated with local vascular injuring during theoperation which may affect the prognosis when it brings benefit.Intensive treatment with statins inperioperation of PCI have been proved effective in the latest studys.These benefits may come frombiology multiple effect of statins including improving Endothelial function,anti-inflammatory,antioxidant,stabling plaque,restraining platelet aggregation and mobilizingendothelial progenitors cells.The mechanism have not been confirmed.Exploring the mechanism ofthe benefit of statins treatment in PCI perioperative and comparing the effect of different statin re-load dosages can help making the rational usage of statins in PCI perioperative.Objective：Investigate the influence of atorvastatin reload and different reload dosages inperioperation of PCI to circulating endothelial progenitor cells(EPCs) and soluble cell adhesionmolecules-1(sICAM-1).Method:Randomise the patients with long-term statins treatment who choose elective PCI withstable angina into three groups: first group:no statin reload treatment before PCI;second group:40mg atorvastatin for7days continuously before PCI; third group:80mg atorvastatin12h before PCI,then additional40mg atorvastatin2h before PCI..Utilize the flow cytometry to determine CD45-/133+/34+EPCs, CD45-/CD34+/KDR+EPCs and CD45-/CD144+/KDR+EPCs number in100ulof blood from all patients.The blood was determined1h before PCI,and1h,6h and24h after PCIrespectively.Utilize ELISA kit to determine the concentration of sICAM-1immediately before PCIand24h after adopting the method of enzyme-linked immunosorbent assay. Laboratorytesting:Utilize scattered color nephelometry to measure the level of CRP preoperative instantly andpostoperative24h. utilize the Immunochromatography to measure the level of aTnI preoperativeinstantly and postoperative24h.Result：(1)The number of CD45-/133+/34+EPCs and CD45-/CD34+/KDR+EPCs before PCIfrom80mg atorvastatin group compared with one hour after PCI was57.3±9.4vs74.4± 11.4/100ul(P<0.05) and57.3±10.7vs78.8±16.2/100ul(P<0.05),respectively.The number ofCD45-/133+/34+EPCs and CD45-/CD34+/KDR+EPCs from80mg atorvastatin group beforePCI compared with six hours after PCI was57.3±9.4vs93±16.9/100ul(P<0.05) and57.3±10.7vs99.7±11.9/100ul(P<0.05), respectively.However,there were no significant difference in allthree groups of CD45-/CD144+/KDR+EPCs comparison of preoperative and postoperative.The40mg statin group and no statin group had no significant difference when comparing the number ofEPCs from the preoperative to the postoperative.(2)The level of CRP and sICAM-1at24hoursafter PCI had significantly increase comparing to preoperative from no statin load group174.55±38.91vs204.11±58.24ng/ml(P<0.05) and1.89±1.93vs9.0±11.1mg/L(P<0.05).The level ofCRP and sICAM-1from80mg statin load group and40mg statin load group at24hours after PCIhad a decreasing trend compare to no statin load group.Comparing to no statin load group,the levelof aTnI at24hours after PCI from80mg statin load group decreased the increased ratesignificantly.The result was0.06±0.08vs1.74±3.09ng/ml(P<0.05).Conclusion:(1). In the long term statins therapy patients,the method of40mg atorvastatin for7days continuously before PCI does not improve the level of perioperative EPCs.(2).High-doseatorvastatin reloading before PCI in short time can increase the number of perioperative cycleendothelial progenitor cells which were at earlier stage.(3).Comparing to no statin loadgroup,atorvastatin reloading before PCI can reduce inflammation and myocardial injuryresponding to PCI in perioperative. |
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