负荷剂量瑞舒伐他汀对于非ST段抬高型心梗死患者经皮冠状动脉介入治疗前后肌醇磷酸酶1水平及预后的影响

doi:10.3969/j.issn.1004-583X.2019.06.010

临床荟萃

负荷剂量瑞舒伐他汀对于非ST段抬高型心梗死患者经皮冠状动脉介入治疗前后肌醇磷酸酶1水平及预后的影响

1.武威市人民医院心血管内科，甘肃武威 733000； 2.兰州市人民医院心内科，甘肃兰州 730050

出版日期:2019-06-20 发布日期:2019-08-02
通讯作者: 曾令伟，Email: lvshangyi100@126.com
基金资助:
甘肃省自然科学基金资助项目----不同剂量瑞舒伐他汀对急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后
心肌再灌注的影响研究（16JR4RB469）

Effect of load dosage rosuvastatin on src homology2containing inositol phosphatase 1 level and prognosis in patients with nonST segment elevation myocardial infarction before and after percutaneous coronary intervention

1.Department of Cardiology, Wuwei People's Hospital, Wuwei 733000, China;
2. Department of Cardiology, Lanzhou People's Hospital, Lanzhou 733050, China

Online:2019-06-20 Published:2019-08-02
Contact: Corresponding author: Zeng Lingwei, Email: lvshangyi100@126.com

摘要/Abstract

摘要： 目的探究负荷剂量瑞舒伐他汀对于急性非ST段抬高型心肌梗死（non STsegment elevation myocardial infarction, NSTEMI）患者经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）前后肌醇磷酸酶1 (Src homology2containing inositol phosphatase 1, SHIP1)水平及预后的影响。方法选择2015年6月至2018年4月间于武威市人民医院就诊的96例急性NSTEMI患者，随机数表法分为试验组（48例）和对照组（48例），两组患者均进行常规PCI治疗，且试验组术前应用负荷剂量的瑞舒伐他汀，随访180天，比较两组PCI手术前及术后12、24小时血清肌钙蛋白I（cardiac Troponin I, cTnI）、磷酸肌酸激酶同工酶（creatine kinase isoenzyme, CKMB）、PCI术前及术后24小时的白细胞介素6（interleukin, IL6）、肿瘤坏死因子α(tumor necrosis factor, TNFα)和γ干扰素(interferon, IFNγ)水平以及微小RNA155(miR155)和SHIP1相对表达量、累积主要不良心血管事件（major adverse cardiovascular events，MACE）发生情况及药物的不良反应发生情况。结果术前两组cTnI和CKMB水平差异无统计学意义（P＞0.05）；术后12小时，两组cTnI和CKMB水平均上升，但术后24小时均明显下降，且试验组在两个时期的指标均显著低于对照组（P＜0.01）。术前两组IL6、TNFα和IFNγ水平差异无统计学意义（P＞0.05）；术后24小时，两组IL6、TNFα和IFNγ水平均明显升高，且试验组的各项指标均低于对照组（P=0.000）。术前两组miR155和SHIP1相对表达量差异无统计学意义（P=0.121, 0.515）；术后24小时，两组miR155均明显增高，且试验组的miR155相对表达量低于对照组（P=0.000），试验组的SHIP1相对表达量明显高于对照组（P=0.000）。试验组和对照组PCI术后180天内MACE发生率分别为16.67%（8/48）和37.50%（18/48），试验组MACE发生风险低于对照组（P=0.038）。试验组消化道出血、恶心呕吐、皮疹及头晕的不良反应总发生率（10.41%）与对照组（14.59%）差异无统计学意义（P=0.757）。结论 PCI术前负荷剂量瑞舒伐他汀能通过抑制miR155/SHIP1信号转导通路恢复NSTEMI患者PCI治疗后的心肌酶水平，降低炎症反应，改善患者预后。

关键词: 心肌梗死, 瑞舒伐他汀, 非ST段抬高型心肌梗死, 肌醇磷酸酶

Abstract: Objective To investigate the effect of load dosage rosuvastatin on src homology2containing inositol phosphatase 1 level (SHIP1) and prognosis in patients with nonST segment elevation myocardial infarction (NSTEMI) before and after percutaneous coronary intervention (PCI). Methods A total of 96 patients with NSTEMI in Wuwei people's Hospital between June 2015 and April 2018 was randomly enrolled into the treatment group (48 cases) and the control group (48 cases). All patients in both groups were treated by PCI while patients in treatment group were treated by load dosage rosuvastatin (20 mg 12 h and 2 h before PCI, respectively), both groups were followedup for 180 days. The cTnI, CKMB, IL6, TNFα, IFNγ, SHIP1, miR155, MACE and adverse drug reaction of both groups were comparatively analyzed. Results No significant difference in cTnI and CKMB levels between the both groups was found before PCI (P＞0.05); at 12h after PCI, the levels of cTnI and CKMB in both groups increased, and decreased significantly at 24 hours after PCI, among which, the cTnI and CKMB of the treatment group was significantly lower than those of control group (P＜0.01). No significant difference in IL6, TNFαand IFNγ levels was found between the two groups before PCI (P＞0.05), at 24 h after PCI, the levels of IL6, TNFαand IFNγ in in both groups increased while these indexes in the treatment group were significantly lower than those of the control group(P=0.000). No significant difference in relative expression of miR155 and SHIP1 was found between the two groups before PCI (P＞0.05), the level of miR155 increased in both groups while it was lower in the treatment group than in the control group (P＜0.01) and the level of SHIP1 in the treatment group was higher than that of the control group(P＜0.01). The incidence of MACE within 180 days after PCI in the treatment group and in the control group was 16.67% (8/48) and 37.50% (18/48), respectively, while the risk of MACE of inpatients in the treatment group was significantly lower than that of control group (P=0.038). No significant difference existed in the total rate of adverse drug reaction between the two groups (10.41% vs 14.59%, P=0.757). Conclusion The preoperative load dosage of PCI can restore the myocardial enzyme level of NSTEMI patients after PCI treatment by inhibiting miR155/SHIP1 signal transduction pathway, reduce inflammatory response and improve the prognosis of NSTEMI patients.

Key words: myocardial infarction, load dosagerosuvastatin, non STsegment elevation myocardial infarction, src homology2containing inositol phosphatase

曾令伟1,杨晶1，张亮1，丁悦2. 负荷剂量瑞舒伐他汀对于非ST段抬高型心梗死患者经皮冠状动脉介入治疗前后肌醇磷酸酶1水平及预后的影响[J]. 临床荟萃, doi: 10.3969/j.issn.1004-583X.2019.06.010.

Zeng Lingwei1, Yang Jing1, Zhang Liang1, Ding Yue2. Effect of load dosage rosuvastatin on src homology2containing inositol phosphatase 1 level and prognosis in patients with nonST segment elevation myocardial infarction before and after percutaneous coronary intervention[J]. Clinical Focus, doi: 10.3969/j.issn.1004-583X.2019.06.010.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2019.06.010

https://huicui.hebmu.edu.cn/CN/Y2019/V34/I6/535

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负荷剂量瑞舒伐他汀对于非ST段抬高型心梗死患者经皮冠状动脉介入治疗前后肌醇磷酸酶1水平及预后的影响

Effect of load dosage rosuvastatin on src homology2containing inositol phosphatase 1 level and prognosis in patients with nonST segment elevation myocardial infarction before and after percutaneous coronary intervention

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