短期大剂量阿托伐他汀对初发急性前壁心肌梗死患者左心室重构的影响

doi:10.24920/11810

摘要/Abstract

摘要：

目的评估短期大剂量阿托伐他汀治疗对初发前壁心肌梗死患者高敏C反应蛋白（hs-CRP）,丙二醛（MDA）、内皮素（ET-1）,基质金属蛋白酶（MMPs）及左心室重构的影响。方法 103例成功施行经皮冠脉介入治疗（PCI）的初发前壁心肌梗死的住院患者随机分为两组：强化治疗组（n=49）入院后即给予阿托伐他汀40mg/日,维持1周,其后给予20mg/日;标准治疗组（n=54）给予阿托伐他汀20mg/日。在入院时、发病1周、2周及6个月随访时分别检测血浆hs-CRP, MDA, ET-1, MMP-2 和 MMP-9水平。在入院时、发病2周及1年随访时分别进行彩色超声心动检查评估左室舒张末容积（LVEDV）、左室收缩末容积（LVESV）和左室射血分数（LVEF）。比较上述实验室指标和左心室重构指标在强化治疗组和标准治疗组之间的差异。结果在心肌梗死发病后一周时强化治疗组血浆 hs-CRP（F=7.718, P=0.009）、ET-1（F=7.882, P=0.006）、MMP-9（F=4.834, P=0.028）和pro-BNP(F=4.603, P=0.032)的浓度明显低于标准治疗组;随访1年时两组患者的左室重构指标LVEDV（t=0.722, P=0.444）,LVESV（t=1.228, P=0.221）和LVEF（t=1.354, P=0.187）值无明显差异。结论心肌梗死后给予短期大剂量阿托伐他汀可以有效降低血中hs-CRP、ET-1和MMP-9的水平,但对左室重构并无明显影响。

关键词: 阿托伐他汀, 急性心肌梗死, 高敏C反应蛋白, 基质金属蛋白酶, 左室重构

Abstract:

Objects The aim of this trial was to evaluate the effect of short-term high-dose atorvastatin therapy on levels of high-sensitivity C-reactive protein (hs-CRP), malonaldehyde (MDA), endothelin-1(ET-1), matrix metalloproteinases (MMPs), and left ventricular (LV) remodeling in patients with first time attack of acute anterior myocardial infarction (AAMI) .Methods A hundred and three patients with first time attack of AAMI who underwent successful primary percutaneous coronary intervention were randomized to receive atorvastatin 40 mg once daily for 1 week followed by 20 mg once daily (intensive treatment group, IT group, n=49), or atorvastatin 20 mg once daily (standard treatment group, ST group, n=54). Plasma levels of hs-CRP, MDA, ET-1, MMP-2 and MMP-9 were measured on admission, at 1 week, 2 weeks and 6 months follow up and compared between the IT group and ST group. Echocardiography was performed on admission, at 2 week, and 1 year follow up. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF) were measured at each echocardiographic examination and compared between the IT group and ST group.Results Plasma levels of hs-CRP (F=7.718, P=0.009), ET-1 (F=7.882, P=0.006), MMP-9 (F=4.834, P=0.028) and pro-BNP (F=4.603, P=0.032) were significantly lower at 1 week after initial onset of AAMI in the IT group compared with the ST group. The changes of LVEDV, LVESV, and LVEF at the 1 year follow-up from the admission did not differ between the IT group and the ST group (t=0.722, P=0.444; t=1.228, P=0.221; t=1.354, P=0.187, repectively).Conclusions Short-term high-dose atorvastatin treatment for AAMI was associated with lower hs-CRP, ET-1 and MMP-9 levels compared to the standard dose treatment. However, this beneficial effect is not likely to related to the left ventricular remodeling.

Key words: atorvastatin, acute myocardial infarction, high-sensitivity C-reactive protein, Matrix metalloproteinases, left ventricular remodeling

Liu Zhijian, Hu Gaopin, Fei Meiying, Yin Zao, Shi Quanxing, Sun Fei. Effects of Short-term High Dose Atorvastatin on Left Ventricular Remodeling in Patients with First Time Attack of Anterior Acute Myocardial Infarction[J].Chinese Medical Sciences Journal, 2018, 33(2): 84-90.

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Clinical characteristics	ST group (n=54)	IT group (n=49)	t/χ²value	P value
Age, years	64±11	61±10	1.188	0.239
Gender
Male, n (%)	35(64.8)	33(67.3)	0.073	0.682
Female, n (%)	19(35.2)	16(32.7)
Risk factors
Hypertension, n (%)	15(27.8)	16(32.7)	0.290	0.590
Diabetes Mellitus, n (%)	13(24.1)	10(20.4)	0.199	0.655
smoking, n (%)	21(38.9)	14(28.6)	1.219	0.270
Laboratory parameters
HDL-C, mmol/L	1.57±0.36	1.66±0.38	1.014	0.315
LDL-C, mmol/L	3.24±0.75	3.11±0.75	0.774	0.466
Peak CK-MB, U/L	188.8±135.5	221.0±141.6)	0.872	0.352
PCI parameters
Time from onset to revascularization, min	387±174	327±168	0.726	0.161
Single-vessel /multi-vessel	41/13	35/14	0.269	0.604
Contrast media volume, ml	142±29	154±38	1.512	0.135
Medications after PCI
Aspirin, n (%)	54(100)	49(100)	NA	NA
Clopidogrel, n (%)	54(100)	49(100)	NA	NA
Beta blockers, n (%)	46(85.2)	40(81.6)	0.235	0.628
ACE-I or ARB, n (%)	44(81.5)	38(77.6)	0.245	0.621

Patient group	Pro-BNP, ng/L				Fvalue	Hs-CRP, mg/L				Fvalue
Patient group	admission	1 week	2 weeks	6 months	Fvalue	admission	1 week	2 weeks	6 months	Fvalue
IT group (n=49)	438±291	298±222^*	311±241	305±209	14.875	9.6±3.2	6.1±2.7^*	3.6±1.8^#	3.0±1.5	81.369
ST group (n=54)	445±236	397±253	344±261	328±245	3.369	9.8±3.6	7.7±3.2^*	4.5±2.0^#	3.4±1.7^?	73.066
F value	0.382	4.603	1.981	0.413		0.140	7.718	5.532	1.172
P value	0.510	0.032	0.144	0.368		0.709	0.009	0.021	0.282
Patient group	ET-1, ng/L				F value	MDA, nmol/l				F value
Patient group	admission	1 week	2 weeks	6 months	F value	admission	1 week	2 weeks	6 months	F value
IT group (n=49)	68.8±12.4	50.6±10.9^*	41.1±10.6^#	35.7±8.4^?	105.460	12.0±2.6	5.1±2.3^*	3.8±1.3^#	3.6±1.3	140.583
ST group (n=54)	66.1±11.5	57.7±253^*	44.5±10.7^#	37.9±9.9^?	97.477	11.2±2.4	5.3±1.8^*	4.2±1.5^#	4.0±1.5	138.848
F value	1.215	7.882	2.587	1.397		2.557	0.621	0.204	0.164
P value	0.273	0.006	0.111	0.240		0.113	0.429	0.604	0.782
Patient group	MMP-2, μg/L				Fvalue	MMP-9, μg/L				Fvalue
Patient group	admission	1 week	2 weeks	6 months	Fvalue	admission	1 week	2 weeks	6 months	Fvalue
IT group (n=49)	270±110	236±103^*	241±111	218±88^?	2.635	93±47	57±28^*	46±25^#	39±20^?	47.039
ST group (n=54)	259±106	240±103^*	232±99	210±93^?	1.047	97±47	77±42^*	51±28^#	41±24^?	15.443
F value	0.218	0.104	0.168	0.142		0.711	4.834	0.434	0.551
P value	0.688	0.881	0.721	0.771		0.723	0.028	0.501	0.614

Echocardiographic parameter	Time points	ST group (n=54)	IT group (n=49)	t value	P value
LVEDV, ml	Admission	108±17	103±16	1.184	0.241
	2 weeks	109±17	104±17	1.079	0.294
	1 year	119±17^*	115±19^#	0.722	0.444
	Δ	10.8±5.6	12.3±6.7	1.041	0.311
LVESV, ml	Admission	55±10	51±11	1.081	0.207
	2 weeks	54±11	52±11	1.157	0.287
	1 year	54±9	51±13	1.228	0.221
	Δ	-0.3±4.6	-0.4±3.5	0.092	0.927
LVEF, n(%)	Admission	49±7	50±8	0.734	0.551
	2 weeks	50±7	51±8	0.423	0.693
	1 year	54±7^?	56±8^?	1.354	0.187
	Δ	4.7±3.3	6.0±4.6	1.488	0.154

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