目的探讨尿激酶联合阿托伐他汀在ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者中的临床应用价值。方法选取本院于2013年1月—2015年2月收治的84例STEMI患者为研究对象,随机抽样法分成联合组和对照组2组,各42例。对照组采用予以单纯尿激酶溶栓疗法(150万U注射用重组人尿激酶原+100ml生理盐水混合后静脉滴注,0.5 h内滴注完毕,后常规使用低分子肝素抗凝治疗),联合组采用尿激酶溶栓联合阿托伐他汀(溶栓治疗前口服80 mg,溶栓后的次日起每日口服20 mg,长期维持)口服用药方案比对两组患者治疗前后超敏C反应蛋白(high sensitive C-reactive protein,hs-CRP)、白介素-6(inter leukelin-6,IL-6)等指标变化情况,记录其胸痛缓解时间、酶峰出现时间、ST段回落指标的差异,分析其冠脉再通率、不良心血管事件发生率及不良反应发生率的差异。计量资料比较采用t检验,计数资料比较采用χ~2检验,P<0.05为差异有统计学意义。结果治疗2周后,两组患者血浆hs-CRP及血清IL-6水平均较治疗前显著降低,其中联合组低于对照组[(2.8±0.7)mg/L、(9.7±1.3)ng/L、(3.6±0.6)mg/L、(17.4±2.4)ng/L],对比差异均有统计学意义(均P<0.05)。两组胸痛缓解时间对比无统计学意义(P>0.05)。联合组酶峰出现时间显著低于对照组[(12.2±1.1)、(13.2±1.2)h],ST段回落程度则显著高于对照组[(1.2±0.3)、(0.9±0.3)mv],对比差异均有统计学意义(均P<0.05)。两组用药后的不良反应发生率及心律失常发生率对比无统计学意义(P>0.05)。联合组梗死后心绞痛、心力衰竭(心衰)、再发性心肌梗死、心脏性死亡等不良心血管事件发生率均显著低于对照组,且冠脉再通率为78.5%,显著高于对照组的57.1%,对比差异均有统计学意义(均P<0.05)。结论将阿托伐他汀联合尿激酶方案应用于STEMI患者的临床治疗中,疗效确切,可有效促进其病情转归、降低不良血管事件发生风险,且用药安全性突出,对于患者预后提升有利。 Objective To investigate the clinical value of urokinase combined with atorvastatin in patients with ST-segment elevation myocardial infarction (STEMI). Methods Eighty-four patients with STEMI admitted to our hospital from January 2013 to February 2015 were selected as the study subjects and randomly divided into two groups (n = 42 in each group). The control group was treated with urokinase thrombolysis (1.5 million U injection of recombinant human urokinase + 100ml saline mixed intravenous drip infusion within 0.5 h after the completion of routine use of low molecular weight heparin anticoagulant therapy), combined Group treated with urokinase thrombolysis combined with atorvastatin (oral administration of 80 mg before thrombolytic therapy, daily oral administration of 20 mg from the day after thrombolysis, long-term maintenance) oral medication program than two groups of patients before and after treatment of hypersensitivity C reaction (Hs-CRP), interleukin-6 (IL-6) and other indicators were recorded. The difference of chest pain relief time, peak of enzyme peak and ST-segment depression index were recorded. Analysis of the rate of coronary recanalization, the incidence of adverse cardiovascular events and the incidence of adverse reactions. Measurement data were compared using t test, count data were compared using χ ~ 2 test, P <0.05 for the difference was statistically significant. Results After two weeks of treatment, the levels of plasma hs-CRP and serum IL-6 in the two groups were significantly lower than those before treatment, and the combined group was lower than that in the control group [(2.8 ± 0.7) mg / L, (9.7 ± 1.3) ng / L, (3.6 ± 0.6) mg / L, (17.4 ± 2.4) ng / L] respectively. There were significant differences between the two groups (all P <0.05). There was no significant difference in the relief time of chest pain between the two groups (P> 0.05). (12.2 ± 1.1), (13.2 ± 1.2) h], and the ST-segment regression was significantly higher than that of the control group [(1.2 ± 0.3), (0.9 ± 0.3) mv] , The differences were statistically significant (P <0.05). There was no significant difference between the two groups in the incidence of adverse reactions and the incidence of arrhythmia (P> 0.05). The incidence of adverse cardiovascular events such as angina pectoris, heart failure (CHF), recurrent myocardial infarction and cardiac death in the combined group was significantly lower than that in the control group, and the rate of coronary recanalization was 78.5%, significantly higher than that of the control Group 57.1%, the difference was statistically significant (P <0.05). Conclusions The application of atorvastatin combined with urokinase in the clinical treatment of STEMI patients has definite curative effect, which can effectively promote the prognosis of patients with STEMI and reduce the risk of adverse vascular events. The drug safety is prominent and the prognosis of patients with STEMI is improved.