Effects of atorvastatin on systemic inflammatory response after coronary bypass surgery
Effects of atorvastatin on systemic inflammatory response after coronary bypass surgery
复制标题
DOI：
10.1097/01.ccm.0000201407.89977.ea
复制
发表时间：
2006-03-01
影响因子：
8.8
通讯作者：
Covino, E
中科院分区：
文献类型：
--
作者：
Chello, M;Patti, G;Covino, E
目标.冠状动脉旁路移植术后经常发生全身炎症反应，并且与术后发病率和死亡率密切相关。最近的研究表明，他汀类药物治疗与炎症相关变量（如C-反应蛋白、细胞因子和粘附分子）的显著和显著降低相关。因此，我们研究了术前阿托伐他汀治疗对体外循环术后全身炎症反应和围手术期发病率的影响。双盲、安慰剂对照、随机研究。地点：大学医院。患者：40名患者在手术前3周随机接受阿托伐他汀（20 mg/天，A组，n = 20）或安慰剂（组B，n 20）治疗。干预措施：阿托伐他汀20 mg/天治疗三周。测量和主要结果。术后血清白细胞介素-6和白细胞介素-8水平均显著高于基线水平，但阿托伐他汀组术后4小时观察到的峰值水平显著低于基线水平。以同样的方式，中性粒细胞上的CD 11b表达在术后4和24小时，他汀类药物组显著降低。最后，与对照组相比，他汀类药物患者的嗜酸性粒细胞-内皮细胞粘附显著降低。两组之间的手术时间、失血量、对正性肌力支持的需求、插管时间和重症监护室或住院时间没有显著差异。两组术后第1天和第2天的全身炎症反应综合征评分相似。阿托伐他汀预处理可显著减少体外循环冠状动脉旁路移植术患者细胞因子释放和中性粒细胞粘附于静脉内皮。
Objectives. Systemic inflammatory response occurs frequently after coronary artery bypass surgery, and it is strongly correlated with the risk of postoperative morbidity and mortality. Recent studies demonstrate that treatment with statin is associated with a significant and marked decrease in inflammation-associated variables such as the C-reactive protein, cytokines, and adhesion molecules. Therefore, we investigated the effects of preoperative atorvastatin treatment on systemic inflammatory response and perioperative morbidity after cardiopulmonary bypass.Design. Double-blinded, placebo-controlled, randomized study.Setting: University hospital.Patients: Forty patients were randomized to treatment with atorvastatin (20 mg/day, group A, n = 20) or placebo (group B, n 20) 3 wks before surgery.Interventions: Three-week treatment by atorvastatin 20 mg/ day.Measurement and Main Results. Postoperative serum levels of both interleukin-6 and interleukin-8 increased significantly over baseline, but the peak levels observed 4 hrs postoperatively were significantly lower in the atorvastatin group. In the same fashion, CD11b expression on neutrophils was significantly lower in the statin group at 4 and 24 hrs postoperatively. Finally, neutrophil-endothelial adhesion was significantly reduced in the statin patients compared with controls. The operation time, blood loss, need for inotropic support, intubation time, and length of intensive care unit or hospital stay did not differ significantly between the two groups. The systemic inflammatory response syndrome score on postoperative days 1 and 2 was comparable in both groups.Conclusions. Pretreatment with atorvastatin significantly reduces cytokine release and neutrophil adhesion to the venous endothelium in patients undergoing coronary artery bypass grafting with cardiopulmonary bypass.