Intensive Statin Thetapy’s Effect In PCI Intervention And Its Influence To APN, MMP-9, And TNF-α

Objectives: Although intensive statin therapy has been confirmed bymany research,because these study are to non-Asian patients for main researchobject, the effect which in Chinese patients, especially the security has notbeen determined.So intensive statin therapy in China has not been generallyaccepted,in some interventional centers, according to the operator’s experienceand clinical judge they select some patients who were given intensive dose ofststin drugs. But it didn’t forme a standardization treatment programme,theeffect in and outside of statin decrease lipid are proportional to dosage, Thehospitalized elective PCI patients in China before operation are around one tothree days, during this time if they can be repeatedly given intensive dose ofstatin drugs, which may have further benefits on patients’s prognosis.This study is to assess the effects of intensive statin treatment to coronaryheart disease patients with PCI meanwhile we observe adiponectin (APN),matrix metalloproteinase (MMP-9) and tumor necrosis factor-α (TNF-α)serum levels change.This experiment is divided into intensive treatment andconventional therapy group, analysis both in patients with non-ST-segmentelevation acute coronary syndromes (NSTE-ACS) or stable angina (SAP) inthe lipid-lowering effects, assess the impact of both on major cardiovascularevents, such as security issues, as well as the analysis of both the APN,MMP-9, similarities and differences of the influence degree of changes inserum levels of TNF-α.Method:1Inclusion criteria:Select between June2010and June2011patients who were admitted inTangshan Gongren Hospital cardiology, all the patients were given PTCA addstent implantation therapy according to the results of coronary angiography and clinical symptoms who were diagnosed with NSTE-ACS or SAP, thepatients were divided into two groups, patients’ age, sex, SA, UA, whetherhave hypertension, whether use of nitrates、anticoagulants in the two groupsare comparable.2Exclusion criteriaIn eight weeks patients with the use of statin drugs; Plan6months againPCI therapy patients; Elected to the former LDL-C<1.8mmol/L; Diagnosis ofmyopathy or elevated muscle enzymes (Creatine phosphate in muscle enzyme> twice times the normal maximum); White blood cell count <4x109/L, orplatelet count in patients with <100x109/L; Severe renal insufficiency(creatinine>3mg/DL or264umol/L); Allergic to HMG-CoA reductaseinhibitors, or past due to taking this type of medication or consideredunsuitable for serious adverse reactions in patients taking statin drugs; Mergedheavy of active pulse flap narrow or mitral valve narrow, and hypertrophy typemyocardial disease, and pericardial disease, and merged malignant tumors orany other end late disease led to expected life <6months,3Therapy MehtodsSelect80cases, selected after informed consent, the patients weredivided into conventional treatment groups40cases and intensive therapygroup40cases, and intensive group immediately oral80mg atorvastatincalcium after admission, preoperative oral80mg again before PCI the secondday, postoperative oral40mg1/day for1month; Conventional groupadmission immediately oral atorvastatin calcium20mg after admission,20mg1/day for1month after PCI. After admission and for1month after eachextraction and venous blood centrifugal, leave a serum immediately.4ELISA MehtodsBy ELISA method in determination of serum APN, MMP-9, TNF-acontent5Statistical analysisApplied statistical analysis software version SPSS13.0, the mainstatistical indicators for normal inspection and homogeneity of variance tests, the statistics are (x±s); comparison of two sets of measurement data usingt-test. Multiple sets of measurement data analysis using ONE-WAY ANOVA,comparison between22SNK-q test. Double-sided P<0.05differentstatistically.Results:1Effect Comparison (lipid decreased)Intensive atorvastatin group of lipid-lowering effect30days wassignificantly better than conventional atorvastatin group2Security (liver function)(cardiovascular events-clinic and telephonefollow-up)PCI for a month after the two groups were free from majorcardiovascular events occur, liver function tip: intensive statin therapy grouphad2cases of abnormal liver enzymes, ALT, AST<3times normal value limit,conventional statin treated group1cases of abnormal liver enzymes, no ALTor AST>3times the normal maximum value, the difference was notstatistically significant (P>0.05).3Inflammatory factorsExtraction of venous blood was given immediately after admission, Therewas no significant difference about the serum inflammatory factor APN,MMP-9, TNF-a between intensive statin group and conventional statin group(P>0.05).A month after intensive statin therapy group compared to theconventional statin treated group, more significantly elevated levels of serumAPN, and MMP-9, TNF-a level declined significantly, the differences arestatistically significant (P<0.05).Conclusions:1Atorvastatin calcium can elevate levels of serum APN, decrease thelevels of MMP-9, TNF-a.2Intensive atorvastatin calcium treatment in peri-operative patientswith PCI are better able to raise the level of serum APN, lower MMP-9,TNF-a level, and it can reduce vascular inflammation better. 3PCI perioperative intensive treatment with atorvastatin calciumcompared to conventional atorvastatin calcium treatment for1month,thesecurity of major cardiovascular events, as well as to the liver should befurther observed.