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目的观察急性冠状动脉综合征合并心房颤动患者行PCI术后,他汀类药物对围手术期心肌损伤的保护作用。方法选择具备PCI指征的急性冠状动脉综合征患者247例,分为合并心房颤动组(心房颤动组)132例和未合并心房颤动组(未心房颤动组)115例,在PCI术前开始服用他汀类药物,分别测量PCI术前及术后6h及1周时肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)及高敏C反应蛋白(hs-CRP)水平。结果 2组患者PCI术前CK-MB水平比较差异无统计学意义(P>0.05),心房颤动组患者cTnI、hs-CRP高于未心房颤动组(P<0.05);PCI术后6h,2组患者cTnl、CK-MB和hs-CRP均明显升高,心房颤动组升高更明显(P<0.05);PCI术1周后,2组患者上述指标均有所下降,心房颤动组下降较未心房颤动组明显,但未回复到术前水平。结论对急性冠状动脉综合征合并心房颤动的患者行PCI治疗,他汀类药物抗炎、保护心肌作用更强,其机制可能与他汀类药物的多效性相关。
Objective To observe the protective effects of statins on perioperative myocardial injury after PCI in patients with acute coronary syndrome and atrial fibrillation. Methods A total of 247 acute coronary syndrome patients with PCI indications were enrolled in this study. They were divided into two groups: 132 patients with atrial fibrillation (atrial fibrillation group) and 115 patients without atrial fibrillation (atrial fibrillation group) Statins were used to measure the levels of cTnI, CK-MB and hs-CRP at 6 h and 1 week after PCI. Results There was no significant difference in CK-MB level before PCI between the two groups (P> 0.05). The levels of cTnI and hs-CRP in patients with atrial fibrillation were higher than those without atrial fibrillation (P <0.05) The levels of cTnl, CK-MB and hs-CRP were significantly increased in group C and increased more significantly in atrial fibrillation group (P <0.05). After 1 week of PCI, the above indexes were decreased in both groups and decreased in atrial fibrillation group Not atrial fibrillation group was obvious, but did not return to the preoperative level. Conclusions PCI in patients with acute coronary syndrome complicated with atrial fibrillation is more effective than statin in protecting myocardium from myocardial infarction. Its mechanism may be related to the pleiotropic effects of statins.