ST 段抬高型心肌梗死患者入院前他汀类药物治疗与炎症反应的关系。

Association of pre-admission statin therapy and the inflammatory response in ST elevation myocardial infarction patients.

机构信息

a Department of Cardiology , Tel Aviv Sourasky Medical Center; Affiliated to the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv , Israel.

出版信息

Biomarkers. 2019 Feb;24(1):17-22. doi: 10.1080/1354750X.2018.1460765. Epub 2018 Dec 9.

DOI:10.1080/1354750X.2018.1460765

PMID:29620476

Abstract

PURPOSE

To demonstrate the possible association of statin therapy with C reactive protein (CRP) serial measurements in ST elevation myocardial infarction (STEMI) patients.

MATERIALS AND METHODS

STEMI patients between 2008 and 2016 with available CRP data from admission were divided into two groups according to pre-admission statin therapy. A second CRP measurement was noted following primary coronary intervention (within 24 h from admission). The difference between the two measurements was designated ΔCRP.

RESULTS

The cohort consisted of 1134 patients with a median age of 61 (IQR52-70), 81% males. Patients on statins prior to admission (336/1134, 26%) were more likely to have CRP levels within normal range (≤5 mg/l) compared to patients without prior treatment, both at admission (75 vs. 24%, p = 0.004) and at 24 h (70 vs. 48%, p = 0.029). The prevalence of patients with pre-admission statin therapy decreased as ΔCRP increased (p = 0.004; n = 301). The likelihood of ΔCRP to be above 5 mg/l in patients with pre-admission statin therapy was reduced after age and gender adjustments (OR 0.54, 95% CI 0.32-0.92, p = 0.023) and in multivariate (OR 0.57, 95% CI 0.33-0.99, p = 0.048) analysis.

CONCLUSIONS

Pre-admission statin therapy is associated with a less robust inflammatory response in STEMI patients, highlighting statin's pathophysiological importance.

摘要

目的

展示他汀类药物治疗与 ST 段抬高型心肌梗死（STEMI）患者 C 反应蛋白（CRP）连续测量值之间可能的关联。

材料和方法

根据入院前他汀类药物治疗情况，将 2008 年至 2016 年间入院时可获得 CRP 数据的 STEMI 患者分为两组。在初次经皮冠状动脉介入治疗（入院后 24 小时内）后，注意到第二次 CRP 测量值。将两次测量值之间的差值指定为ΔCRP。

结果

该队列由 1134 名中位年龄为 61 岁（IQR52-70）的患者组成，其中 81%为男性。与未接受治疗的患者相比，入院前服用他汀类药物的患者（336/1134，26%）更有可能处于正常 CRP 水平（≤5mg/L），入院时（75% vs. 24%，p=0.004）和 24 小时时（70% vs. 48%，p=0.029）均如此。随着ΔCRP 的增加，入院前接受他汀类药物治疗的患者比例下降（p=0.004；n=301）。在校正年龄和性别后，入院前接受他汀类药物治疗的患者ΔCRP 超过 5mg/L 的可能性降低（OR 0.54，95%CI 0.32-0.92，p=0.023），且在多变量分析（OR 0.57，95%CI 0.33-0.99，p=0.048）中也如此。