Wang Yan-Bo, Fu Xiang-Hua, Gu Xin-Shun, Fan Wei-Ze, Jiang Yun-Fa, Hao Guo-Zhen, Miao Qing, Cao Jie, Fu Bing, Li Yi
The Second Hospital of Hebei Medical UniversityShijiazhuang 050000, China.
Am J Cardiovasc Dis. 2017 Jul 25;7(4):89-96. eCollection 2017.
This study aimed to investigate the effects of intensive pitavastatin therapy on glucose control in patients with non-ST elevation acute coronary syndrome (ACS). Patients who had ACS with significant stenosis on initial coronary angiography and received successful percutaneous coronary intervention (PCI) in the Second Hospital of Hebei Medical University, Shijiazhuang, China from August 2015 to January 2016 were enrolled in this study. The patients were randomized to receive pitavastatin (4 mg daily) or atorvastatin (20 mg daily). PCI was performed within 72 hours after admission according to the current clinical practice at the physician's discretion. The examinations of blood lipid levels and blood markers of glucose metabolism were performed at baseline and after 6-month follow-up using standard techniques. The inflammatory markers, including white blood cell, high-sensitivity C-reactive protein (hs-CRP) and fibrinogen, were also assessed before PCI and 24 hours after PCI. An independent adverse event assessment committee evaluated major adverse cardiovascular events (MACE) and any other adverse events. A total of 132 patients were enrolled and randomly divided into the pitavastatin group (n = 65) or the atorvastatin group (n = 67), which had similar baseline characteristics and PCI procedural characteristics. For the inflammatory biomarkers at 24 hours after PCI, the fibrinogen level was significantly increased in the atorvastatin group; the hs-CRP levels were significantly increased in both groups, however, the hs-CRP level in the pitavastatin group was lower than that in the atorvastatin group. In addition, the blood lipid parameters (e.g., TC, LDL-C, TG, non-HDL-C and Apo B) were significantly decreased in both groups after 6-month follow-up ( < 0.01), but these parameters between the two groups had no significant difference. After 6-month follow-up, the FPG, IRI, HOMA-IR and HbA levels were significantly decreased in the pitavastatin group ( < 0.05) but slightly increased in the atorvastatin group, indicating that the glucose homeostasis was improved in patients in the pitavastatin group but not in the atorvastatin group. Furthermore, the incidence of MACE was not significantly different between the two groups ( > 0.05). After 6-month antiplatelet treatment, the PAR value was significantly decreased in both groups ( < 0.01), but the PAR value in the pitavastatin group was lower than that in the atorvastatin group. Pitavastatin therapy may improve the glucose homeostasis for patients with ACS undergoing PCI and has more favorable outcomes than atorvastatin therapy.
本研究旨在探讨强化匹伐他汀治疗对非ST段抬高型急性冠状动脉综合征（ACS）患者血糖控制的影响。2015年8月至2016年1月期间，在中国石家庄河北医科大学第二医院，对初始冠状动脉造影显示有明显狭窄且接受成功经皮冠状动脉介入治疗（PCI）的ACS患者进行了研究。将患者随机分为接受匹伐他汀（每日4mg）或阿托伐他汀（每日20mg）治疗组。根据当前临床实践，由医生酌情决定在入院后72小时内进行PCI。使用标准技术在基线和6个月随访后检测血脂水平和糖代谢血液标志物。还在PCI前和PCI后24小时评估炎症标志物，包括白细胞、高敏C反应蛋白（hs-CRP）和纤维蛋白原。一个独立的不良事件评估委员会评估主要不良心血管事件（MACE）和任何其他不良事件。共有132例患者入组并随机分为匹伐他汀组（n = 65）或阿托伐他汀组（n = 67），两组的基线特征和PCI手术特征相似。对于PCI后24小时的炎症生物标志物，阿托伐他汀组的纤维蛋白原水平显著升高；两组的hs-CRP水平均显著升高，然而，匹伐他汀组的hs-CRP水平低于阿托伐他汀组。此外，6个月随访后两组的血脂参数（如总胆固醇、低密度脂蛋白胆固醇、甘油三酯、非高密度脂蛋白胆固醇和载脂蛋白B）均显著降低（<0.01），但两组之间这些参数无显著差异。6个月随访后，匹伐他汀组的空腹血糖（FPG）、胰岛素抵抗指数（IRI）、稳态模型评估的胰岛素抵抗（HOMA-IR）和糖化血红蛋白（HbA）水平显著降低（<0.05），而阿托伐他汀组略有升高，表明匹伐他汀组患者的血糖稳态得到改善，而阿托伐他汀组未改善。此外，两组之间MACE的发生率无显著差异（>0.05）。6个月抗血小板治疗后，两组的血小板聚集率（PAR）值均显著降低（<0.01），但匹伐他汀组的PAR值低于阿托伐他汀组。匹伐他汀治疗可能改善接受PCI的ACS患者的血糖稳态，且比阿托伐他汀治疗有更有利的结果。
