| Objective: This paper aims to investigate the effect of Tongxinluo combined with Atorvastatin Calcium Tablets(A Le)on myocardial damage and short-term prognosis in STEMI patients with PCI procedure.Methods: In this paper,96 acute STEMI patients that met the inclusion criteria who went to see a doctor in The First Affiliated Hospital of Henan University of traditional Chinese Medicine from March 2016 to April 2017 were divided into 3groupsrandomly.group A:10mg atorvastatin group(the patients took 10 mg atorvastatin orally before and after PCI procedure everyday),group B:20mg atorvastatin group(the patients took 20 mg atorvastatin orally before and after PCI procedure everyday),group C:10mg atorvastatin Combined with Tongxinluo capsule group,(the patients took 10 mg of atorvastatin a day Combined with 2.08 grams Tongxinluo capsule at a lord dose 3 times a day before PCI procedure and 10 mg of Atorvastatin a day Combined with 1.04 grams Tongxinluo capsule at a lord dose 3times a day after PCI procedure),There are 32 cases in each group,3 groups of patients took pills according to the above plan for four-consecutive-week.Thereafter,the patient adjusted the statin dose under the guidance of a physician according to its blood lipid levels.The occurrence of major adverse cardiovascular events in 3 groups of patients for 4 weekswas recorded.All the patients received conventional western medicine treatment(including Aspirin Tablets,clopidogrel tablets,etc.)before PCI procedure.The general clinical data of the patients were recorded and the preoperative examinations were improved.We measured the changes of the indexes in the three groups patients before and after the operation,the indexes consist of creatine kinase isoenzyme(CK-MB),troponin I(cTnI),alanine aminotransferase(ALT),blood lipid levels[including: triglyceride(TG),total cholesterol(TC),high density lipoprotein(HDL-C),low density lipoprotein(LDL-C)],brain natriuretic peptide(BNP),high sensitive C reactive protein(hs-CRP),interleukin 6(IL-6)and so on,the relative data of 3 groups of patients with PCI surgery is compared at the same time.The patients underwent cardiac ultrasonography at the second day,1weeks,4weeks later after the operation,and the changes of ventricular wall motion and left ventricular ejection fraction(LVEF)were recorded.We inspected the liver and kidney function closely during the period of taking medicine,recorded the main adverse reactions in time,and summarized the relevant data.Result:1 Basic data comparison: 3 groups of patients showed no statistical significance(P>0.05)on the comparative differences of indicators including:number of entries,gender,age,body mass index(Body Mass,Index,BMI),time of onset,smoking,previous disease history,preoperative heart function classification(Killip classification)and so on.2 Biochemical comparison before operation: 3 groups of patients showed no statistical significance(P>0.05)on the comparative differences of indicators including: CK-MB,cTnI,ALT,TG,TC,HDL-C,LDL-C,BNP,hs-CRP,IL-6 and so on before the operation.3 Comparison of the intervention data: the comparative differences of the 3 groups of patients showed no statistical significance(P>0.05)in the respects of the number of coronary vessels,the number of stent implantation,the time of PCI operation,the classification of TIMI blood flow before and after the PCI procedure.4 Compare the use of other drugs during the test period: mainly drug treatment in the 3 groups during the test,including the beta blockers,ACEI/ARB,clopidogrel,Aldosterone receptor blocker,had no statistical significance(P > 0.05)5 Comparison of CK-MB,cTn I after the procedure.CK-MB and cTn I levels of 3groups of patients were significantly increased(P<0.05)at the second day after the procedure;the level of CK-MB?cTnI in patiengts of group A was significantly higher at the third day and one week later after the operation compared with group B and group C,the difference between the groups was statistically significant(P<0.05),while the comparison of group B and group C showed no obvious difference(P>0.05).6 The comparison of BNP,hs-CRP and IL-6 levels after operation: the BNP,hs-CRP and IL-6 levels at the second day after operation was higher than preoperative(P<0.05),the comparative differences of the BNP level showed statistical significance at the second day after the operation between the 3 groups(P=0.003<0.05);The BNP,hs-CRP and IL-6 levels of A group were significantly higher than that of group B and group C(P<0.05)1 week and 4 weeks later after the operation,as for group B and group C,the comparison differences between the two groups were not significantly different(P>0.05).7 Comparison of serum lipid level after the operation: the comparative differences between groups of TC,TG,LDL-C,HDL-C levels showed no statistical significance(P > 0.05)at the second day and one week later after the operation among three groups;4 weeks after operation,the comparative differences between groups of TC,TG,LDL-C,HDL-C levels showed statistical significance(P < 0.05)among the groups,the patients in the group A showed higher TC,TG and LDL-C levels than that of group B and group C,there was statistically significant between the differences(P < 0.05),the comparative difference of group B and group C was not obvious(P > 0.05),the HDL-C level of C group was higher than that of A group and B group.There was statistically significant between the differences(P=0.034 < 0.05),the comparative difference of group A and group B was not obvious,(P=0.686 >0.05).8 Comparison of cardiac ultrasound indicators: The comparative differences of LVEF value of groups of B and C compared with that of group A showed statistically significant(P<0.05)at the 1stweek and 4th week later after the operation.At 4th weekafter operation,the WMSI value of A group was significantly higher than that of group B and group C(P<0.05),but there was no significant difference between group B and group C(P>0.05).9 MACE incidence rate: 4 weeks after procedure,the incidence of MACE in group A was 30.00%,higher than that of group B and group C(P=0.024< 0.05),and there was no significant difference between group B and group C(P=0.668> 0.05).10 Comparison of drug safety: with the treatment lasted for 4 weeks,the patients in group B showed higher incidence of the increased ALT level,muscle,bone and joint system pain and gastrointestinal discomfort than the other two groups that were compared,the comparative differences were statistically significant(P<0.05),the comparative between group A and group C showed no significant difference(P >0.05).Conclusion:1 The treatment of 10 mg Atorvastatin Combined with Tongxinluo can reduce the myocardial damage mark of STEMI patients after PCI procedure,reduce inflammation,improve the compliance rate of blood lipid,inhibiting left ventricular remodeling and improve left ventricular function and reduce the incidence rate of MACE better compared with the treatment of pure 10 mg atorvastatin.2 The treatment of 10 mg Atorvastatin Combined with Tongxinluo showed almost the same effect on the improvement the myocardial damage mark of STEMI patients after PCI procedure,reducing inflammation,reducing TC,TG,LDL-C level and inhibiting left ventricular remodeling and improving cardiac function,reducing the effect of MACE compared with the treatment of 20 mg doses of atorvastatin,the difference is not obvious,but in the perspective of improving the success rate of HDL-C,the first treatment is more useful.3 The patients in the group with the treatment of 10 mg Atorvastatin Combined with Tongxinlu showed less adverse reactions with liver and kidney damage and myosalgia compared with the treatment of 20 mg atorvastatin,this treatment can provide high medicinal safety and is worthy of further research and promotion. |
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