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目的评价普罗布考与阿托伐他汀联合治疗对急性心肌梗死患者经皮冠状动脉介入治疗后左室重构的影响,探讨其可能的机制。方法急性心肌梗死患者132例,随机分为阿托伐他汀治疗组(n=68,阿托伐他汀20mg/d)和联合治疗组(n=64,阿托伐他汀20 mg/d+普罗布考1 000 mg/d)。两组患者均行冠状动脉造影及经皮冠状动脉介入治疗。分别于入院时及治疗后4周、12周检测活性氧、丙二醛、高敏C反应蛋白、白细胞介素6、N末端脑钠肽、血脂、左室质量指数及左室射血分数。结果治疗12周后联合治疗组的低密度脂蛋白胆固醇、活性氧、丙二醛、高敏C反应蛋白、白细胞介素6、N末端脑钠肽均较阿托伐他汀治疗组明显下降[(1.75±0.46)mmol/l VS(1.89±0.53)mmol/l,(990.8±412.8)IU/ml VS(1194.6±418.3)IU/ml,(4.45±1.92)μmol/l VS(5.87±2.57)μmol/l,(0.52±0.08)mg/l VS(0.63±0.23)mg/l,(0.45±0.30)pg/ml VS(0.60±0.15)pg/ml,(212.32±67.32)pg/ml VS(272.46±57.38)pg/ml](P<0.01)。超声结果显示治疗12周后与阿托伐他汀治疗组相比,联合治疗组左室质量指数明显下降[(106.5±17.1)g/m2VS(111.5±18.3)g/m2]。结论普罗布考联合阿托伐他汀可减轻急性心肌梗死患者经皮冠状动脉介入治疗后炎症反应,降低氧化应激水平,改善左室重构。
Objective To evaluate the effect of probucol combined with atorvastatin on left ventricular remodeling after percutaneous coronary intervention in patients with acute myocardial infarction and to explore its possible mechanism. Methods A total of 132 patients with acute myocardial infarction were randomized into atorvastatin group (n = 68, atorvastatin 20 mg / d) and combination therapy group (n = 64, atorvastatin 20 mg / d plus probucol 1 000 mg / d). Two groups of patients underwent coronary angiography and percutaneous coronary intervention. Active oxygen, malondialdehyde, high-sensitivity C-reactive protein, interleukin-6, N-terminal pro brain natriuretic peptide, blood lipid, left ventricular mass index and left ventricular ejection fraction were detected at admission and 4 weeks and 12 weeks after treatment. Results Compared with atorvastatin treatment group, LDL cholesterol, reactive oxygen species, malondialdehyde, high-sensitivity C-reactive protein, interleukin-6 and N-terminal pro brain natriuretic peptide in combination therapy group decreased significantly after treatment for 12 weeks ± 0.46 mmol / l VS 1.89 ± 0.53 mmol / l, 990.8 ± 412.8 IU / ml VS 1194.6 ± 418.3 IU / ml vs 4.45 ± 1.92 μmol / l VS 5.87 ± 2.57 μmol / (0.52 ± 0.08) mg / l VS (0.63 ± 0.23) mg / l, (0.45 ± 0.30) pg / ml vs (0.60 ± 0.15) pg / ml and (212.32 ± 67.32) pg / ml vs 57.38) pg / ml] (P <0.01). The results of ultrasound showed that the left ventricular mass index decreased significantly ([(106.5 ± 17.1) g / m2VS (111.5 ± 18.3) g / m2] in the combined treatment group compared with the atorvastatin group after 12 weeks of treatment. Conclusions Probucol combined with atorvastatin can reduce the inflammatory reaction, reduce the level of oxidative stress and improve left ventricular remodeling after percutaneous coronary intervention in patients with acute myocardial infarction.