中文摘要：

目的探讨强化他汀治疗对急性冠脉综合征患者PCI术后心肌灌注的影响及可能机制。方法行择期PCI的急性冠脉综合征患者228例,随机分为标准他汀组（n=115）和强化他汀组（n=113）。于PCI术前7 d,纪录PCI后的TIMI血流、纠正的TIMI计桢数（CTFC）以及TIMI心肌灌注分级（TMPG）等。于PCI前后测量肌酸磷酸激酶（CK）、CK同工酶MB（CPK-MB）、肌钙蛋白I（TnI）、高敏C反应蛋白（hs-CRP）、P选择素和细胞间黏附分子（ICAM）水平。结果强化他汀组支架置入后TIMI血流0~1级显著少于标准他汀组,3级显著多于标准他汀组（P〈0.05）。强化他汀组无复流发生率显著低于标准他汀组（P〈0.001）。CTFC在强化他汀组显著低于标准他汀组（P〈0.001）。强化他汀组的TMPG也显著优于标准他汀组（P=0.001）。PCI术后24 h,CPK-MB和TnI在强化他汀组显著低于标准他汀组〔CPK-MB：（18.74±8.41）ng/ml vs（21.78±10.64）ng/ml,P=0.018;TnI：（0.99±1.07）ng/ml vs（1.47±1.54）ng/ml,P=0.006〕。标准治疗组CK-MB升高者占27.8%（32/115）,强化他汀组则只有15.9%（18/113）（P=0.030）。标准他汀组TnI升高者显著多于强化他汀组〔36.5%（42/115）vs 19.5%（22/113）,P=0.04〕,其中,标准他汀组的心肌坏死发生率为13%（15/115）,而在强化他汀组仅为4.4%（5/113）（P=0.021）。PCI术后24 h,强化他汀组的hs-CRP、P选择素及ICAM水平均显著低于标准他汀组（P〈0.001）。结论 PCI术前使用强化他汀治疗比标准他汀治疗能更有效改善急性冠脉综合征患者的心肌灌注、减轻心肌损伤。同时伴有hs-CRP、P选择素和ICAM-1水平显著降低。

英文摘要：

Objective To study the effect of intensive statin pretreatment on acute coronary syndrome（ACS） patients treated with percutaneous coronary intervention（PCI）,and probe into the mechanisms.Methods A total of 228 ACS patients were randomly divided into standard statin group（SSG,n=115） and intensive statin group（ISG,n=113）.Patients in SSG were given 20 mg simvastatin and patients in ISG were given 80 mg simvastatin for 7 days before PCI.TIMI grade flow（TGF）,corrected TIMI frame count（CTFC） and TIMI myocardial perfusion grade（TMPG） of the intervened vessel were recorded before and after stent deployment.CPK isoenzyme MB,troponin I and plasma level of hs-CRP,P-selectin and ICAM were measured before and 24 hours after the procedure.Results The TFG after stent deployment was significantly improved with less TIMI 0-1 patients and more TIMI 3 blood flow in ISG than those in SSG（all P〈0.05）.Patients with no reflow phenomenon were less in ISG（P〈0.001）.The CTFC was lower in ISG than that in SSG（P〈0.001）.TMPG was also improved in ISG than that in SSG（P=0.001）.Twenty-four hours after the procedure,although PCI caused significant increase in CK-MB,the elevated CK-MB value was lower in ISG than that in SSG（18.74±8.41 vs 21.78±10.64,P=0.018）.Similar changes were also found with regard to Troponin I（0.99±1.07 vs 1.47±1.54,P=0.006）.CK-MB elevation was occurred in 27.8%（32/115） in SSG versus 15.9%（18/113） in ISG（P=0.030）.Among them,myocardial necrosis was detected in 4.4%（5/115） of the patients in SSG,whereas 0.9%（1/113） in ISG （P=0.341）.No myocardial infarction was found.Similarly,the patients with increased troponin I were much more in SSG（36.5%,42/115） than that in ISG（19.5%,22/113）（P=0.04）.Among them,myocardial necrosis was detected in 13%（15/115） of the patients in SSG,while 4.4%（5/113） in ISG（P=0.021）.Myocardial infarction was found in 4.4%（5/115） in the patients in SSG and 0.9%（1/113） in ISG（P=0.213）.Conclu