卜云涛,边波,万征,王清,李永乐,杜鑫,孙跃民

• 1:天津医科大学总医院心血管病中心

摘要(Abstract)：

目的观察急性心肌梗死直接经皮冠状动脉介入治疗(PCI)患者血浆非对称性二甲基精氨酸(Asymmetric Dimethylarginine,ADMA)浓度的变化及阿托伐他汀对其影响。方法本实验入选了27例正常冠状动脉者(对照组)和63例急性ST段抬高型心肌梗死患者(STEMI组)。根据服用阿托伐他汀的剂量不同,将STEMI患者分为常规剂量组(术前服用阿托伐他汀20mg,继以20mg,1次/晚,至出院后30d)和大剂量组(术前服用阿托伐他汀80mg,继以40mg,1次/晚,至出院后30d)。所有对象于入院后取静脉血,STEMI患者术后第3天时再次取静脉血,用于血浆ADMA浓度的测定。结果 (1)STEMI组患者血浆ADMA浓度术前和术后3d时分别为(1.36±0.34)μmol/L和(1.74±0.30)μmol/L,均较对照组(0.78±0.18)μmol/L升高。(2)STEMI组患者血浆ADMA浓度在PCI术后3d时较术前升高,分别为(1.74±0.30)μmol/L和(1.36±0.34)μmol/L。(3)STEMI患者不同剂量组间血浆ADMA浓度术后3d时,大剂量组低于常规剂量组,分别为(1.59±0.27)μmol/L和(1.80±0.30)μmol/L。结论 STEMI患者血浆ADMA浓度升高,且在PCI术后3d时继续升高,提示冠状动脉内皮功能受损。在STEMI患者PCI围术期服用大剂量阿托伐他汀较常规剂量可抑制血浆ADMA的升高,提示发挥内皮保护作用。

关键词(KeyWords)： 阿托伐他汀;血管成形术,经腔,经皮冠状动脉;心肌梗死;非对称性二甲基精氨酸

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 卜云涛,边波,万征,王清,李永乐,杜鑫,孙跃民

参考文献(References)：

• [1]Gennaro Colonna VD,Bianchi M,Pascale V,et al.Asymmetric dimethylarginine(ADMA):An endogenous inhibitor of nitric oxide synthase and a novel cardiovascular risk molecule.Med Sci Monit,2009,15:91-101.
• [2]Schulze F,Lenzen H,Hanefeld C,et al.Asymmetric dimethylarginine is an independent risk factor for coronary heart disease:results from the multicenter Coronary Artery Risk Determination investigating the Influence of ADMA Concentration(CARDIAC)study.Am Heart J,2006,152:1-8.
• [3]Segarra G,Medina P,Ballester RM,et al.Effects of some guanidine compounds on human cerebral arteries.Storke,1999,30:2206-2210.
• [4]赵雷,张吉凤,赵佳怡,等.ADMA对人脐静脉内皮细胞粘附功能影响的体外研究.中国实验诊断学,2010,14:185-187.
• [5]Scalera F,Borlak J,Beckmann B,et al.Endogenous nitric oxide synthesis inhibitor asymmetric dimethylarginine accelerates endothelial cell senescence.Arterioscler Thromb Vasc Biol,2004,24:1816-1822.
• [6]卜云涛,边波,万征.非对称性二甲基精氨酸和冠状动脉性心脏病及其危险因素的关系.中国循证心血管医学杂志,2011,3:63-66.
• [7]Sydow K,Munzel T.ADMA and oxidative stress.Atherosclerosis Suppl,2003,4:41-51.
• [8]Zweier JL,Talukder MA.The role of oxidants and free radicals in reperfusion injury.Cardiovasc Res,2006,70:181-190.
• [9]Bustos C,Hernàndez-Presa MA,Ortego M,et al.HMG-CoA reductase inhibition by atorvastatin reduces neointimal inflammation in a rabbit model of atherosclerosis.J Am Coll Cardiol,1998,32:2057-2064.
• [10]Ito A,Tsao PS,Adimoolam S,et al.Novel mechanism for endothelial dysfunction:dysregulation of dimethylarginine dimethylaminohydrolase.Circulation,1999,99:3092-3095.
• [11]边波,孙跃民,万征.他汀类药的抗心律失常作用:从临床循证证据到分子机制.中国心脏起搏与心电生理杂志,2009,23:377-381.