| Objective:The purpose of this study was to investigate whether the treatment with different doses of atorvastatin can reduce the incidence of no-reflow after PCI operation, whether endothelial function and oxidative stress can be improved after the UAP patients underwent elective PCI, and explored whether the mechanism of improving no-reflow phenomenon was related with the improvement of vascular endothelial functions and oxidative stress in vivo.Method:The experiment selected UAP patients admitted in the Fourth Hospital of Jinan from May 2013 to January 2015 and the patients with negative myocardial injury marker were scheduled for elective PCI. The patients were randomly divided into 3 groups, group A as control group (without using statins before preoperative PCI, only receiving routine treatment); group B as high dose of atorvastatin group. The patients underwent the pretreatment for two days in addition to the routine treatment. The patients were given atorvastatin 80mg QD. After 2d, the patients were given atorvastatin 40mg QD for one month; Group C was low dose of atorvastatin group, the preoperative patients received the routine treatment and the pretreatment for 2d; The patients were given atorvastatin 40mg QD. After 2d, the patients were given atorvastatin 20mg QD for one month. We conducted the following studies. Firstly, we explored whether atorvastatin could reduce the occurrence rate of postoperative no-reflow of PCI. We intended to give different doses of atorvastatin for postoperative treatment for PCI patients, observed TIMI blood flow grading and the levels of cTnT, CK and CK-MB in different groups of patients, analyzed whether it could decrease no-reflow/slow-flow phenomenon and adverse cardiac events of patients. Secondly, we explored whether atorvastatin had impact on oxidative stress to the patients after PCI. We gave different doses of atorvastatin as postoperative treatment for the patients after PCI, observed the changes of plasma ACP, SOD, LZM, T-AOC, XOD, CAT, MDA and other antioxidant indexes in different groups in preoperative and postoperative 3 days, analyzed whether it could improve oxidative stress in vivo. Thirdly, we explored whether atorvastatin had impact on vascular endothelial function in the patients after PCI. We gave different doses of atorvastatin for postoperative treatment for the patients after PCI, observed the concentration changes of EDD, EID, ET and NO in different groups in preoperative and postoperative 3 months, analyzed whether it could repair vascular endothelial cells of patients, so as to improve endothelial function.Result:1. After PCI, the patients whose TIMI blood flow grading was grade 3 in high dose group and low dose group increased from preoperative 36 cases and 40 cases to postoperative 47 cases and 45 cases respectively. The occurrence probabilities of no-reflow in high dose group and low dose group were 4% and 6% respectively, significantly lower than 14% in control group. The probabilities of occurrence of slow-flow were 6% and 8% respectively, significantly lower than 16% in control group (P<0.05); The contents of CK in high dose group and low dose group increased from preoperative 172.87±27.8μ/L and 178.86±43.3μ/L to postoperative 188.32±39.6μ/L and 185.61±35.2μ/L, slightly lower than that in control group, but the difference was not significant (P>0.05); The content of CK-MB increased from preoperative 17.53±7.8μ/L and 14.70±4.5μ/L to postoperative 36.5±16.1μ/L and 31.18±15.9μ/L, slightly lower than that in control group, but the difference was not significant (P>0.05); The content of cTnT in high dose group and low dose group decreased from preoperative 0.20±0.04ng/l and 0.21±0.05ng/l to postoperative 0.17±0.03ng/l and 0.15±0.04ng/l, significantly lower than 0.36±0.06ng/l in control group (P<0.01); The cases of recurrent angina (6 cases and 11 cases) and myocardial infarction (2 cases and 4 cases) in high dose group and low dose group in postoperative 3 months were significantly lower than those in control group (18 cases and 10 cases) (P<0.05).2. After PCI, the contents of T-AOC in high dose group and low dose group improved from preoperative 22.33±9.2U/ml and 21.25±7.4U/ml to postoperative 27.56±6.2U/ml and 22.45±6.1U/ml. The content of T-AOC in the high dose group was significantly higher than 15.82±3.3U/ml in control group (P<0.05); The contents of CAT in high dose group and low dose group improved from preoperative 4.91±1.6U/ml to 5.03±0.8U/ml. The content of CAT in low dose group decreased from preoperative 4.82±1.5U/ml to postoperative 4.44±0.9U/ml. The content of CAT in high dose group was significantly higher than 2.91±1.2U/ml in control group (P< 0.05); The content of SOD improved from preoperative 38.04±11.4U/ml to postoperative 41.57±6.5U/m. The content of SOD in low dose group decreased from preoperative 40.20±10.7U/ml to postoperative 33.96±2.6U/m. The content of SOD in the high dose group was significantly higher than 25.15±5.5U/ml in control group (P <0.05); The preoperative content of XOD in high dose group was 30.04±12.2U/L, while the postoperative content significantly decreased to 5.88±2.3U/L (P<0.05). The preoperative content of XOD in low dose group was 31.14±10.7U/L, while the postoperative content significantly decreased to 10.89±5.4U/L (P<0.05). The content of XOD in high dose group was significantly lower than 27.19±9.1U/L in control group (P<0.05); The contents of MDA in high dose group and low dose group decreased from preoperative 10.55±5.3U/L and 11.27±1.4U/L to postoperative 11.14±4.6U/L and 12.05±2.7U/L in control group, and the difference was not significant compared with that in control group (P>0.05); The contents of plasma ACP in high dose group and low dose group increased from preoperative 10.55±5.3U/L and 11.27±1.4U/L to postoperative 11.14±4.6U/L and 12.05±2.7U/L, and the difference was not significant compared with that in control group (P>0.05); The contents of LZM in high dose group and low dose group increased from preoperative 12.94±4.3μg/ml and 11.22±3.0μg/ml to postoperative 19.22±8.2μg/ml and 17.16±5.4μg/ml, and the difference was not significant compared with that in control group (P> 0.05).3. After PCI for 7 days, the content of EDD in high dose group was 11.63±3.1%, significantly higher than 6.74±1.8% in control group (P<0.05). The content of EDD in high dose group significantly increased to 14.32±4.7%(P<0.01). The content of EDD in low dose group significantly increased to 17.85±6.2%(P<0.05); After PCI, the content of EID in all groups gradually increased. After 3 months, the content of EID in control group increased to 22.64±5.3%, high dose group increased to 30.02±11.8%, low dose group increased to 28.34±7.9%, and the differences between all groups were not significant (P>0.05); 3 months after PCI, the content of vascular ET in high dose group significantly decreased from preoperative 107.73±28.1ng/l to 35.77±9.1ng/l (P<0.05). The content of vascular ET in low dose group significantly decreased from preoperative 111.37±41.3ng/L to 37.22±9.3ng/l (P<0.05). The contents of ET in high dose group and low dose group were significantly lower than 55.73±9.2ng/l in control group (P<0.05); 3 months after PCI, the content of serum NO in high dose group significantly increased from preoperative 51.29±7.4 mol/L to 83.45±8.2 mol/L (P<0.05). The content of serum NO in low dose group significantly increased from preoperative 51.13±6.3μmol/L to 73.81±12.6μmol/L (P<0.05). The content of serum NO in high dose group was significantly higher than 57.24±14.71 in control group (P<0.05).Conclusion:TIMI flow in patients of both high-dose group (80mg/day for 2 days preoperatively,40 mg/day for one month postoperatively) and low dose group (half dosage of high dose group) were elevated, and the flow rate was improved. Statistically significant increase of CK and CK-MB were not observed, but the amount of cTnT showed decrease significantly. The study has also indicated that both of the dosages can effectively lower the chances of no-reflow and/or slow flow phenomenon after primary PCI, chance of secondary heart diseases, sharpen the oxidation resistance ability, decrease myocardial cells damage, increase the vasodilatation function, and therefore produce a good postoperative healing efficacy of PCI. The effect possibly relate to improve endothelial function and the degree of oxidative stress. |
PDF Full Text Request