不同剂量阿托伐他汀对经皮冠状动脉介入治疗后脂联素水平和主要心血管事件的影响

目的探讨不同剂量阿托伐他汀对经皮冠状动脉介入（percutaneous coronary intervention，PCI）治疗后血浆脂联素浓度和主要心血管事件的影响。方法收集64例不稳定型心绞痛患者，随机（按电脑数字随机表法）分为小剂量阿托伐他汀组（32例）和大剂量阿托伐他汀组（32例），分别于PCI治疗前给予阿托伐他汀20mg和40mg口服，PCI治疗后继续予阿托伐他汀20mg／d和40mg／d口服，同时予冠状动脉粥样硬化性心脏病（冠心病）二级预防。分别于入院时、PCI治疗后1个月和6个月采集患者外周血，用于血脂、血糖、高敏C-反应蛋白和脂联素检测。同时比较PCI治疗后6个月两组患者主要心血管事件的发生率。结果（1）两组患者PCI治疗后1个月和6个月各指标均较人院时有所好转，大剂量阿托伐他汀组的改善较小剂量组明显，差异有统计学意义（P〈0．05）；（2）PCI治疗后6个月，小剂量阿托伐他汀组患者主要心血管事件发生率高于大剂量组，差异有统计学意义（15．625％‰9．375％，P〈0．05）；（3）收缩压（r=-0．85，P=0．038）、血浆低密度脂蛋白胆固醇r=-0．91．P=0．005）和高敏C-反应蛋白浓度（r=-0．87，P=0．045）与血浆脂联素浓度呈负相关，而他汀类药物的使用与血浆脂联素浓度呈正相关（r=0．87，P=0．026）；（4）年龄、吸烟、血浆低密度脂蛋白胆固醇和高敏C-反应蛋白浓度的升高都将增加患者PCI治疗后发生主要心血管事件的风险，而较高水平的血浆脂联素浓度以及血管紧张素转移酶抑制剂／血管紧张素受体Ⅱ拮抗剂（ACEI／ARB）和他汀类药物的使用则可降低主要心血管事件发生风险：（5）40mg／d阿托伐他汀与20mg／d具有相似的安全性，并不增加横纹肌溶解或肝功能异常的发生率。结论与小剂量阿托伐他汀相比，大剂量阿托伐他汀治疗方案能够减少不稳定型心绞痛患者PCI治疗后6个月主要心血管事件再发的风险。

Effects of different doses of atorvastatin on adiponectin level and major adverse cardiac events after PCI

Objectives To investigate the effects of different doses of atorvastatin （Ator） on adiponectin （APN） concentration and major adverse cardiac event （MACE） after percutaneous coronary intervention （PCI）. Methods Sixty- four patients defined as unstable angina （UA） were enrolled and randomly assigned into low-dose Ator （32 cases） and high-dose Ator （32 cases） groups. Patients in the two groups were administrated with 20 mg and 40 mg Ator respectively before PCI. Subsequently given 20 mg and 40 mg Ator per day, meanwhile, secondary prevention of coronary artery diseases was performed after PCI. Peripheral blood was obtained at the time point of initial administration, 1 month and 6 months after PCI to evaluate the levels of lipid profile, serum glucose, high-sensitivity C-reactive protein （hs-CRP） and APN. MACE rates in the two groups at 6 months after PCI were also compared. Results （1）The indexes improved at 1 month and 6 months after PCI, especially in high-dose group （P〈0.05） ; （2） Six months after PCI, the MACE rate in low-dose group was significantly higher than that in high-dose group （15.625% vs. 9.375% ,P〈0.05）; （3） Systolic blood pressure （r=-0.85, P=0.038）, serum concentration of low-density lipoprotein cholesterol （LDL-C） （r=-0.91,P= 0.005） and hs-CRP （r=-0.87,P=0.045） were negatively correlated with serum concentration of APN, while statins were positively correlated with APN concentration （r=0.87,P=0.026）; （4）Age, smoking, elevation of serum concentrations of LDL-C and hs-CRP increased the incidence of MACE after PCI, while higher serum concentrations of APN, usage of angiotensin converting enzyme inhibitors/angiotensin receptor blockers and statins decreased the incidence of MACE ;（5）Usage of 40 mg Ator per day was considered as safe as usage of 20 mg Ator per day, without increasing the incidences of rhabdomyolysis and liver dysfunction. Conclusions Compared to the low-dose Ator group, high-dose Ator can reduce the incidence of MACE in patients with UA after 6 months of PCI.