目的 探討不同類型、不同劑量的他汀類藥物對急性心肌梗死（AMI）患者心肌纖維化干預(yù)的效果，找到更為安全可靠的AMI治療藥物。方法 選取中國中醫(yī)科學(xué)院望京醫(yī)院2016年2月-2018年1月收治的AMI患者160例，根據(jù)隨機數(shù)字表法分為4組，各40例。A組采用常規(guī)劑量阿托伐他?。?0 mg/次，1次/d），B組采用負(fù)荷劑量阿托伐他?。?0 mg/次，1次/d），C組采用常規(guī)劑量瑞舒伐他?。?0 mg/次，1次/d），D組采用負(fù)荷劑量瑞舒伐他?。?0 mg/次，1次/d）。治療前、治療1周、治療4周，分別檢測并比較4組患者血脂指標(biāo)、炎性指標(biāo)[超敏C反應(yīng)蛋白（hs-CRP）、白細(xì)胞介素-6（IL-6）]、心肌纖維化指標(biāo)[轉(zhuǎn)化生長因子β1（TGF-β1）、Ⅰ型前膠原羥基末端肽（PICP）、半乳凝素-3（Gal-3）、結(jié)締組織生長因子（CTGF）、Ⅲ型前膠原氨基端肽（PⅢNP）及Ⅰ型膠原羥基末端肽（ⅠCTP）]，同時觀察安全性。結(jié)果 治療前，4組患者血脂指標(biāo)、炎性指標(biāo)、心肌纖維化指標(biāo)水平比較，差異均無統(tǒng)計學(xué)意義；治療1、4周后，4組患者血脂指標(biāo)、炎性指標(biāo)均改善，且D組改善最為顯著，與其他3組比較，差異有統(tǒng)計學(xué)意義（P<0.05）；治療1周，4組患者心肌纖維化指標(biāo)水平均升高，且A組升高最為顯著（P<0.05）；治療4周后，4組患者各心肌纖維化指標(biāo)水平均較治療1周有降低，但D組降低幅度最為顯著，后依次為C組、B組、A組，組間比較差異有統(tǒng)計學(xué)意義（P<0.05）。全部患者在治療期間均未發(fā)生明顯不良反應(yīng)。結(jié)論 瑞舒伐他汀對AMI患者血脂、炎性反應(yīng)、心肌纖維化的影響較阿托伐他汀更佳，在為患者加大負(fù)荷劑量后，心肌纖維化改善效果提升，藥物毒副反應(yīng)未增加，故在AMI耐受的條件下可為其使用大劑量瑞舒伐他汀治療。

Objective To investigate the effects of different types and doses of statins in the intervention of myocardial fibrosis in patients with acute myocardial infarction (AMI), and to find more safe and reliable drugs for AMI.Methods 160 AMI patients in the hospital from February 2016 to January 2018 were selected, and they were divided into four group by random number table, with 40 cases in each group. A group:routine dose of atorvastatin (20 mg, once a day), B group:loading dose of atorvastatin (40 mg, once a day), C group:routine dose of rosuvastatin (10 mg, once a day), D group:loading dose of rosuvastatin (20 mg, once a day). The blood lipid indexes[total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDLC)], inflammatory indexes[hypersensitive C reactive protein (hs-CRP), interleukin-6 (IL-6)], myocardial fibrosis indexes[transforming growth factor-β1 (TGF-β1), procollagen Ⅰ C-terminal peptide (P Ⅰ CP), galectin-3 (Gal-3), connective tissue growth factor (CTGF), type Ⅲ procollagen amino terminal peptide (P Ⅲ NP), type I collagen hydroxy terminal peptide (Ⅰ CTP)] in four groups before treatment, after treatment for 1w and 4w were compared. The safety of four groups were observed.Results Before treatment, there was no statistical difference in the blood lipid indexes, inflammatory indexes and myocardial fibrosis indexes among the four groups. After treatment for 1w and 4 weeks, the blood lipid indexes and inflammatory indexes in four groups improved, and D group improved more significantly compared with other three groups (P<0.05). After treatment for 1w, the levels of myocardial fibrosis indexes in four groups increased, and A group increased more significantly; After treatment for 4w, the levels of myocardial fibrosis indexes in four groups decreased compared with those after treatment for 1w, but the decreased range of D group was the most significant, followed by C group, B group and A group (P<0.05). There were no obvious adverse reactions during treatment. Conclusion Rosuvastatin has better influence on blood lipid, inflammatory response, myocardial fibrosis of AMI patients than atorvastatin. After the application of loading dose, it can improve myocardial fibrosis and not add toxic-side reactions. Therefore, large dose of rosuvastatin can be used for the treatment of AMI under the patients' tolerance.