强化剂量阿托伐他汀对急性心肌梗死患者PCI后血清单核细胞趋化蛋白-1、骨桥蛋白水平变化的影响
|
摘要
目的探讨强化剂量阿托伐他汀对急性心肌梗死(AMI)患者经皮冠状动脉介入治疗(PCI)后血清单核细胞趋化蛋白-1(MCP-1)、骨桥蛋白(OPN)水平变化的影响。方法选取河北省张家口市建国医院于2016年1月至2017年3月的AMI患者82例,用随机数字表法分为阿托伐他汀常规剂量组与阿托伐他汀强化剂量组。检测AMI患者PCI前后的血清OPN、MCP-1和血脂水平,并随访AMI患者PCI后6个月不良心血管事件的发生情况。结果术后1 d、术后1周、术后2周、术后4周两组血清OPN及MCP-1水平较术前增高,但强化剂量组各时期血清OPN及MCP-1水平低于常规剂量组(P<0.05);疗程结束后两组低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、总胆固醇(TC)水平较治疗前降低,高密度脂蛋白胆固醇(HDL-C)水平较治疗前增高,且强化剂量组LDL-C、TG、TC水平低于常规剂量组,HDL-C水平高于常规剂量组(P<0.05);疗程结束后两组左室射血分数较治疗前增高,且强化剂量组高于常规剂量组(P<0.05);强化剂量组不良心血管事件发生率低于常规剂量组(4.88%vs. 19.51%,P<0.05)。结论采取强化剂量阿托伐他汀对采取PCI的AMI患者予以治疗,可抑制血清MCP-1、OPN水平增高,调节血脂含量,且可改善患者心功能,降低不良心血管事件发生风险。
Objective To investigate the influence of atorvastatin in intensive dose on level changes of serum monocyte chemoattractant protein-1(MCP-1) and osteopontin(OPN) in patients with acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI). Methods AMI patients(n=82) were chosen from Jianguo Hospital of Zhangjiakou City in Hebei Province from Jan. 2016 to Mar. 2017, and divided, according to random digital table, into routine dose of atorvastatin group(routine group) and intensive dose of atorvastatin group(intensive dose group). The levels of serum OPN, MCP-1 and blood fat were detected before and after PCI in 2 groups, and incidence of major adverse cardiovascular events(MACE) was followed up after 6 months. Results The levels of serum OPN and MCP-1 increased after PCI for 1 d, 1 week, 2 weeks and 4 weeks in 2 groups, and levels of serum OPN and MCP-1 were lower in intensive dose group than those in routine group(P<0.05) at all time points. The levels of LDL-C, TG and TC decreased and level of HDL-C increased in 2 groups after treatment, and levels of LDL-C, TG and TC were lower and level of HDL-C was higher in intensive dose group than those in routine group(P<0.05). LVEF increased in 2 groups after treatment, and was higher in intensive dose group than that in routine group(P<0.05). The incidence of MACE was lower in intensive dose group than that in routine group(4.88% vs.19.51%, P<0.05). Conclusion Atorvastatin in intensive dose can inhibit the increase of serum MCP-1 and OPN levels, regulate blood fat level, improve heart function and reduce risk of MACE in AMI patients undergone PCI.
Objective To investigate the influence of atorvastatin in intensive dose on level changes of serum monocyte chemoattractant protein-1(MCP-1) and osteopontin(OPN) in patients with acute myocardial infarction(AMI) after percutaneous coronary intervention(PCI). Methods AMI patients(n=82) were chosen from Jianguo Hospital of Zhangjiakou City in Hebei Province from Jan. 2016 to Mar. 2017, and divided, according to random digital table, into routine dose of atorvastatin group(routine group) and intensive dose of atorvastatin group(intensive dose group). The levels of serum OPN, MCP-1 and blood fat were detected before and after PCI in 2 groups, and incidence of major adverse cardiovascular events(MACE) was followed up after 6 months. Results The levels of serum OPN and MCP-1 increased after PCI for 1 d, 1 week, 2 weeks and 4 weeks in 2 groups, and levels of serum OPN and MCP-1 were lower in intensive dose group than those in routine group(P<0.05) at all time points. The levels of LDL-C, TG and TC decreased and level of HDL-C increased in 2 groups after treatment, and levels of LDL-C, TG and TC were lower and level of HDL-C was higher in intensive dose group than those in routine group(P<0.05). LVEF increased in 2 groups after treatment, and was higher in intensive dose group than that in routine group(P<0.05). The incidence of MACE was lower in intensive dose group than that in routine group(4.88% vs.19.51%, P<0.05). Conclusion Atorvastatin in intensive dose can inhibit the increase of serum MCP-1 and OPN levels, regulate blood fat level, improve heart function and reduce risk of MACE in AMI patients undergone PCI.
引文
[1]张巍,赵明,王小凤,等.大剂量阿托伐他汀对急性心肌梗死行急诊PCI患者心肌再灌注损伤的影响[J].现代预防医学,2011,38(21):4545-7.
[2]付文波,丁世芳,陈志楠,等.强化阿托伐他汀对急性心肌梗死急诊介入治疗中无复流的影响[J].中西医结合心脑血管病杂志,2015,13(1):39-41.
[3]Qiu R,Cai A,Dong Y,et al. SDF-1αupregulation by atorvastatin in rats with acute myocardial infarction via nitric oxide production confers anti-inflammatory and anti-apoptotic effects[J]. J Biomed Sci,2012,19(1):99.
[4]李萌萌,王清,万征,等.大剂量阿托伐他汀对急性前壁心肌梗死P C I患者急性对比剂肾损害的预防作用[J].山东医药,2013,53(20):55-7.
[5]张建.大剂量阿托伐他汀联合替罗非班在急性心肌梗死患者PCI治疗中的应用效果[J].中国冶金工业医学杂志,2017,34(5):551-2.
[6]霍玉娥,刘胜辉,王艳飞.阿托伐他汀强化治疗对急性心肌梗死患者PCI术后sFas的影响[J].中国老年学杂志,2015,35(16):4688-9.
[7]杨莉芹,黄小娟,张新颍.高负荷阿托伐他汀对急性心梗PCI患者血脂及心功能的影响[J].临床研究,2015,23(5):286-7.
[8]Hahn JY,Kim HJ,Choi YJ,et al. Effects of atorvastatin pretreatment on infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention[J].Am Heart J,2011,162(6):1026-33.
[9]于洪伟,刘奇峰,江珊.急性心肌梗死患者血清骨桥蛋白水平变化及意义[J].山东医药,2013,53(19):80-1.
[10]杨大春,马双陶,杨永健,等.急性心肌梗死患者单核细胞PPARδ、MCP-1和MMP-9表达及其与冠状动脉病变关系[J].中华实用诊断与治疗杂志,2010,24(11):1048-51.
[11]赵淑兰,许长存.强化阿托伐他汀疗法在PCI治疗首次急性前壁心肌梗死患者中的应用分析[J].北京医学,2016,38(2):110-3.
[12]杨勇,刘英,刘惠亮,等.急诊PCI术前阿托伐他汀强化治疗对STEMI患者血清炎症因子的影响[J].心血管康复医学杂志,2012,21(3):290-4.
[13] Kyoung KE,Joo-Yong H,Song YB,et al. Effects of High-dose Atorvastatin Pretreatment in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention:A Cardiac Magnetic Resonance research[J]. J Korean Med Sci,2015,30(4):435-41.
[14]余淑华,陈晖,刘喜灿.大剂量阿托伐他汀对老年急诊PCI术后患者对比剂肾病的影响[J].中国老年学杂志,2015,35(14):3885-7.
[15]代永红.不同剂量阿托伐他汀对冠心病急性心梗伴心衰行PCI患者血清hs-CRP的影响[J].海南医学院学报,2011,17(2):203-5.
[16]王艳飞,曹雪滨,贾新未,等.老年急性心肌梗死PCI术无复流患者强化阿托伐他汀治疗临床分析[J].中国循证心血管医学杂志,2014,6(6):717-9.
[17]Zemánek D,Branny M,MartinkovicováL,et al. Effect of sevenday atorvastatin pretreatment on the incidence of periprocedural myocardial infarction following percutaneous coronary intervention in patients receiving long-term statin therapy. A randomized research[J]. Int J Cardiol,2013,168(3):2494-7.
[18]金少辉,白秀萍.不同剂量阿托伐他汀对急性心肌梗死并高尿酸血症患者的疗效[J].心血管康复医学杂志,2012,21(4):416-9.
[19]刘胜辉,霍玉娥,李雅.阿托伐他汀强化治疗急性心肌梗死患者PCI术后的疗效及对正五聚蛋白3和中性粒细胞表面黏附分子的影响[J].临床急诊杂志,2017,18(2):137-41.
[20]解金红,陈玉善,罗明华,等.大剂量阿托伐他汀对急性心肌梗死患者行PCI术再灌注后ET、NO、slCAM-1及hs-CRP的影响[J].疑难病杂志,2015,14(5):445-8.
[21]李凯,郝钦芳,刘丽萍,等. PCI术前给予大剂量阿托伐他汀钙对急性心肌梗死患者血清降钙素原和高敏C反应蛋白水平的影响[J].解放军药学学报,2013,29(6):533-5.
[22]王鹏飞,刘培敏,刘再宇,等.不同剂量阿托伐他汀对心肌梗死患者PCI后相关指标及主要不良心血管事件的影响[J].中国药房,2016,27(15):2045-8.
[23]陈海鹏.不同剂量阿托伐他汀对急性心肌梗死急诊PCI治疗患者心率变异性的影响[J].内蒙古医学杂志,2017,49(6):710-1.
[24]Pauriah M,Elder DH,Ogston S,et al. High-potency statin and ezetimibe use and mortality in survivors of an acute myocardial infarction:a population-based research[J]. Heart,2014,100(11):867-72.
[25]王雅坤,蔺莉莉,王茹,等.不同剂量阿托伐他汀对急性心肌梗死患者直接经皮冠脉介入治疗后血清CF-6、p53的影响[J].国际老年医学杂志,2015,36(2):53-6.
[26]尚东丽,刘建华.大剂量阿托伐他汀对急性心肌梗死PCI术患者MMP-9及左心房功能的影响[J].热带医学杂志,2016,16(1):69-71.
[27]张廷明,王东波,王青青. 40 mg阿托伐他汀对急性心肌梗死患者PCI术后hs-cTnT、CK-MB及血脂的影响[J].检验医学与临床,2015,12(24):3711-3.
[28]王京坡,岳龙,张静,等.不同剂量阿托伐他汀对PCI术后急性心肌梗死患者血脂、hs-CRP及心功能的影响[J].现代中西医结合杂志,2017,26(19):2141-3.
[29]张振岭,任澎,马丽,等.不同剂量阿托伐他汀对急性心肌梗死患者冠状动脉介入治疗后早期血脂及近期心血管事件影响的临床研究[J].中国医药,2015,10(7):955-7.
[30]于洪伟,刘奇峰,江珊.急性心肌梗死患者血清骨桥蛋白水平变化及意义[J].山东医药,2013,53(19):80-1.
[31]樊清波,简立国.不同剂量阿托伐他汀对急性心肌梗死急诊行PCI患者血清骨桥蛋白的影响[J].郑州大学学报(医学版),2012,47(6):869-70.
[32]汪丽丽,贺钰梅,张永莉.急性心肌梗死患者血清超敏C反应蛋白、单核细胞趋化蛋白-1表达及临床意义[J].国际检验医学杂志,2017,38(9):1259-61.
[33]陈玺全,邓小军,段青松,等.血清MCP-1、OPG与急性心肌梗死患者PCI后再狭窄的关系[J].海南医学,2017,28(24):3983-5.
[2]付文波,丁世芳,陈志楠,等.强化阿托伐他汀对急性心肌梗死急诊介入治疗中无复流的影响[J].中西医结合心脑血管病杂志,2015,13(1):39-41.
[3]Qiu R,Cai A,Dong Y,et al. SDF-1αupregulation by atorvastatin in rats with acute myocardial infarction via nitric oxide production confers anti-inflammatory and anti-apoptotic effects[J]. J Biomed Sci,2012,19(1):99.
[4]李萌萌,王清,万征,等.大剂量阿托伐他汀对急性前壁心肌梗死P C I患者急性对比剂肾损害的预防作用[J].山东医药,2013,53(20):55-7.
[5]张建.大剂量阿托伐他汀联合替罗非班在急性心肌梗死患者PCI治疗中的应用效果[J].中国冶金工业医学杂志,2017,34(5):551-2.
[6]霍玉娥,刘胜辉,王艳飞.阿托伐他汀强化治疗对急性心肌梗死患者PCI术后sFas的影响[J].中国老年学杂志,2015,35(16):4688-9.
[7]杨莉芹,黄小娟,张新颍.高负荷阿托伐他汀对急性心梗PCI患者血脂及心功能的影响[J].临床研究,2015,23(5):286-7.
[8]Hahn JY,Kim HJ,Choi YJ,et al. Effects of atorvastatin pretreatment on infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention[J].Am Heart J,2011,162(6):1026-33.
[9]于洪伟,刘奇峰,江珊.急性心肌梗死患者血清骨桥蛋白水平变化及意义[J].山东医药,2013,53(19):80-1.
[10]杨大春,马双陶,杨永健,等.急性心肌梗死患者单核细胞PPARδ、MCP-1和MMP-9表达及其与冠状动脉病变关系[J].中华实用诊断与治疗杂志,2010,24(11):1048-51.
[11]赵淑兰,许长存.强化阿托伐他汀疗法在PCI治疗首次急性前壁心肌梗死患者中的应用分析[J].北京医学,2016,38(2):110-3.
[12]杨勇,刘英,刘惠亮,等.急诊PCI术前阿托伐他汀强化治疗对STEMI患者血清炎症因子的影响[J].心血管康复医学杂志,2012,21(3):290-4.
[13] Kyoung KE,Joo-Yong H,Song YB,et al. Effects of High-dose Atorvastatin Pretreatment in Patients with ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention:A Cardiac Magnetic Resonance research[J]. J Korean Med Sci,2015,30(4):435-41.
[14]余淑华,陈晖,刘喜灿.大剂量阿托伐他汀对老年急诊PCI术后患者对比剂肾病的影响[J].中国老年学杂志,2015,35(14):3885-7.
[15]代永红.不同剂量阿托伐他汀对冠心病急性心梗伴心衰行PCI患者血清hs-CRP的影响[J].海南医学院学报,2011,17(2):203-5.
[16]王艳飞,曹雪滨,贾新未,等.老年急性心肌梗死PCI术无复流患者强化阿托伐他汀治疗临床分析[J].中国循证心血管医学杂志,2014,6(6):717-9.
[17]Zemánek D,Branny M,MartinkovicováL,et al. Effect of sevenday atorvastatin pretreatment on the incidence of periprocedural myocardial infarction following percutaneous coronary intervention in patients receiving long-term statin therapy. A randomized research[J]. Int J Cardiol,2013,168(3):2494-7.
[18]金少辉,白秀萍.不同剂量阿托伐他汀对急性心肌梗死并高尿酸血症患者的疗效[J].心血管康复医学杂志,2012,21(4):416-9.
[19]刘胜辉,霍玉娥,李雅.阿托伐他汀强化治疗急性心肌梗死患者PCI术后的疗效及对正五聚蛋白3和中性粒细胞表面黏附分子的影响[J].临床急诊杂志,2017,18(2):137-41.
[20]解金红,陈玉善,罗明华,等.大剂量阿托伐他汀对急性心肌梗死患者行PCI术再灌注后ET、NO、slCAM-1及hs-CRP的影响[J].疑难病杂志,2015,14(5):445-8.
[21]李凯,郝钦芳,刘丽萍,等. PCI术前给予大剂量阿托伐他汀钙对急性心肌梗死患者血清降钙素原和高敏C反应蛋白水平的影响[J].解放军药学学报,2013,29(6):533-5.
[22]王鹏飞,刘培敏,刘再宇,等.不同剂量阿托伐他汀对心肌梗死患者PCI后相关指标及主要不良心血管事件的影响[J].中国药房,2016,27(15):2045-8.
[23]陈海鹏.不同剂量阿托伐他汀对急性心肌梗死急诊PCI治疗患者心率变异性的影响[J].内蒙古医学杂志,2017,49(6):710-1.
[24]Pauriah M,Elder DH,Ogston S,et al. High-potency statin and ezetimibe use and mortality in survivors of an acute myocardial infarction:a population-based research[J]. Heart,2014,100(11):867-72.
[25]王雅坤,蔺莉莉,王茹,等.不同剂量阿托伐他汀对急性心肌梗死患者直接经皮冠脉介入治疗后血清CF-6、p53的影响[J].国际老年医学杂志,2015,36(2):53-6.
[26]尚东丽,刘建华.大剂量阿托伐他汀对急性心肌梗死PCI术患者MMP-9及左心房功能的影响[J].热带医学杂志,2016,16(1):69-71.
[27]张廷明,王东波,王青青. 40 mg阿托伐他汀对急性心肌梗死患者PCI术后hs-cTnT、CK-MB及血脂的影响[J].检验医学与临床,2015,12(24):3711-3.
[28]王京坡,岳龙,张静,等.不同剂量阿托伐他汀对PCI术后急性心肌梗死患者血脂、hs-CRP及心功能的影响[J].现代中西医结合杂志,2017,26(19):2141-3.
[29]张振岭,任澎,马丽,等.不同剂量阿托伐他汀对急性心肌梗死患者冠状动脉介入治疗后早期血脂及近期心血管事件影响的临床研究[J].中国医药,2015,10(7):955-7.
[30]于洪伟,刘奇峰,江珊.急性心肌梗死患者血清骨桥蛋白水平变化及意义[J].山东医药,2013,53(19):80-1.
[31]樊清波,简立国.不同剂量阿托伐他汀对急性心肌梗死急诊行PCI患者血清骨桥蛋白的影响[J].郑州大学学报(医学版),2012,47(6):869-70.
[32]汪丽丽,贺钰梅,张永莉.急性心肌梗死患者血清超敏C反应蛋白、单核细胞趋化蛋白-1表达及临床意义[J].国际检验医学杂志,2017,38(9):1259-61.
[33]陈玺全,邓小军,段青松,等.血清MCP-1、OPG与急性心肌梗死患者PCI后再狭窄的关系[J].海南医学,2017,28(24):3983-5.