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Effect of Atorvastatin on the Concentration of Plasma Asymmetric Dimethylarginine in Acute Myocardial Infarction Patients during PCI Perioperative Period

Author: BoYunTao
Tutor: WanZheng
School: Tianjin Medical University
Course: Internal Medicine
Keywords: atorvastatin percutaneous coronary intervention ST segment elevated myocardial infarction asymmetric dimethylarginine high-sensitivity C-reactive protein
CLC: R541.4
Type: Master's thesis
Year: 2011
Downloads: 5
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Abstract


Objective:1. To observe the changes of plasma asymmetric dimethylarginine (ADMA) and high-sensitivity C-reactive protein(hs-CRP) before and after percutaneous coronary intervention(PCI) in patients with ST-segment elevated myocardial infarction (STEMI).2. To observe the effect of different dose atorvastatin on plasma ADMA and hs-CRP during PCI perioperative period in patients with STEMI.Methods:Sixty-three patients with STEMI enrolled in this experiment, and were treated randomly with lower-dose atorvastatin (lower-dose group,32 patients,20mg before PCI, then 20mg QN till 30 days after patients’discharge) or higher-dose atorvastatin (higher-dose group,31 patients,80mg before PCI, then 40mg QN till 30 days after patients’discharge). Fasting ulnar vein blood was drew from all patients before PCI and 3 days after the operation. The concentration of plasma ADMA was measured by using enzyme linked immunosorbent assay, and the concentration of hs-CRP was measured by immunoturbidimetry. Creatine kinase (CK), alanine amino transferase (ALT), and aspartate amino transferase (AST) were examined in all the patients at admission and discharge. Excluding the effect of myocardial infarction, CK>5 upper limits of normal was defined as muscle damage, and ALT and/or AST>3 upper limits of normal was defined as liver damage. Collected the baseline characteristics and operation data of all patients, and made a telephone follow-up 30 days after patients’ discharge, which included myalgia, hypodynamia, anorexia, postinfarction angina pectoris, recurrent myocardial infarction, a second revascularization, cardiac death, and death of other reasons. SPSS 16.0 was used for statistical analysis. Chi-square test was used to analyze enumeration data. Measurement data were presented as mean values±SD, andτ-tests were used to compare the mean values. The relationship between ADMA and hs-CRP was analysed by Pearson Correlation. Differences were considered statistically significant at p<0.05.Results:1. Concentrations of ADMA and hs-CRP were elevated statistically after PCI in all the STEMI patients when compared to that before PCI (ADMA: 1.36±0.34μmol/L vs.1.74±0.30μmol/L,p=0.000; hs-CRP:9.95±4.50μmol/L vs. 13.49±3.02μmol/L, p=0.000).2. There was no difference of plasma concentration of ADMA or hs-CRP between the two groups at admission, but 3 days after the operation, plasma concentration of ADMA & hs-CRP of higher-dose group was much lower than that of lower-dose group (ADMA:1.59±0.27μmol/L vs 1.80±0.30μmol/L,p=0.005; hs-CRP:12.70±3.30mg/L vs 14.26±2.55mg/L,p=0.039). 3. There was positive correlation between plasma concentration of ADMA and hs-CRP (r=0.618, p=0.000).4. The use of different dose atorvastatin hadn’t resulted in damage to liver and skeletal muscle during PCI perioperative period, and no patients of the two groups had suffered from myalgia, hypodynamia, anorexia or adverse cardiac events during follow-up 30 days after patients’discharge.Conclusion:1. Plasma ADMA and hs-CRP of patients with STEMI are higher than normal level, and that elevate after PCI, which indicates inflammatory reaction and endothelial damage of coronary artery are serious.2. Compared with lower-dose atorvastatin therapy, higher-dose atorvastatin can obviously repress the abnormal elevation of plasma ADMA and hs-CRP during PCI perioperative period in patients with STEMI, which indicates higher-dose atorvastatin therapy can obviously repress the inflammatory reaction and protect the blood vessel endothelium of coronary artery.

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CLC: > Medicine, health > Internal Medicine > Heart, blood vessels ( circulatory ) disease > Heart disease > Coronary arteries ( atherosclerosis ),heart disease (CHD)
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