阿托伐他汀钙对急性冠状动脉综合征患者PCI术后心肌微循环及内皮细胞微粒和C反应蛋白的影响
|
摘要
目的探讨阿托伐他汀钙对急性冠状动脉综合征(ACS)患者经皮冠状动脉介入(PCI)术后心肌微循环及内皮细胞微粒(EMPs)和C反应蛋白(CRP)的影响。方法选择2014年1月～2016年11月四川省阆中市人民医院心内科收治的128例ACS患者为研究对象,按照随机数字表法将其分为对照组和观察组,每组各64例。其中,观察组患者在PCI术前12 h与术前2 h分别给予40 mg阿托伐他汀钙,对照组患者给予等量安慰剂。两组患者其余治疗过程保持一致。采用冠状动脉造影比较两组患者术后7 d的TIMI血流分级;同时比较两组患者治疗前后不同时间点静脉血中EMPs、CRP水平。结果观察组患者治疗后病变远端血流状况显著好于对照组(P <0.05)。重复测量方差分析结果显示,两组患者治疗期间CPR、EMPs水平组间比较、不同时间点比较及组别与时间的交互作用差异均有统计学意义(P <0.05)。两组术前EMPs、CRP水平比较,差异无统计学意义(P> 0.05)。与治疗前比较,两组患者术后1 d EMPs、CRP水平均明显升高,术后14 d均明显下降(P <0.05)。观察组术后1、14 d EMPs、CRP水平均明显低于对照组同期,差异有统计学意义(P <0.05)。结论阿托伐他汀钙可以有效改善ACS患者PCI术后心肌微循环,降低患者术后EMPs、CRP水平,保护内皮细胞,值得临床推广。
Objective To investigate the effects of Atorvastatin Calcium on myocardial microcirculation, endothelial microparticles(EMPs) and C-reactive protein(CRP) in patients with acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI). Methods A total of 128 patients with ACS admitted to the Department of Cardiology,Langzhong People′s Hospital of Sichuan Province from January 2014 to November 2016 were selected as the research objects. They were divided into control group and observation group according to random number table method, 64 cases in each group. Among them, patients in the observation group were given 40 mg Atorvastatin Calcium 12 and 2 hours before PCI respectively, while patients in the control group were given the same amount of placebo. The other treatment processes of the two groups were consistent. TIMI blood flow classification at 7 days after operation was compared by coronary angiography, and the levels of EMPs and ACS in venous blood at different time points before and after treatment were compared between the two groups. Results The blood flow of the distal part of the observation group was significantly better than that of the control group(P < 0.05). The results of repeated measurement variance analysis showed that there were significant differences in CPR and EMPs levels between the two groups during treatment, at different time points, and the interaction between groups and time(P < 0.05). There was no significant difference in EMPs and CRP levels between the two groups before operation(P > 0.05). Compared with before operation, the levels of EMPs and CRP in the two groups were significantly increased at 1 day after operation, and decreased significantly at14 days after treatment(P < 0.05). The levels of EMPs and CRP in the observation group at 1 and 14 days after operation were significantly lower than those in the control group, and the differences were statistically significant(P < 0.05).Conclusion Atorvastatin Calcium can effectively improve myocardial microcirculation, reduce EMPs and CRP levels and protect endothelial cells in ACS patients after PCI, which is worthy of clinical promotion.
Objective To investigate the effects of Atorvastatin Calcium on myocardial microcirculation, endothelial microparticles(EMPs) and C-reactive protein(CRP) in patients with acute coronary syndrome(ACS) after percutaneous coronary intervention(PCI). Methods A total of 128 patients with ACS admitted to the Department of Cardiology,Langzhong People′s Hospital of Sichuan Province from January 2014 to November 2016 were selected as the research objects. They were divided into control group and observation group according to random number table method, 64 cases in each group. Among them, patients in the observation group were given 40 mg Atorvastatin Calcium 12 and 2 hours before PCI respectively, while patients in the control group were given the same amount of placebo. The other treatment processes of the two groups were consistent. TIMI blood flow classification at 7 days after operation was compared by coronary angiography, and the levels of EMPs and ACS in venous blood at different time points before and after treatment were compared between the two groups. Results The blood flow of the distal part of the observation group was significantly better than that of the control group(P < 0.05). The results of repeated measurement variance analysis showed that there were significant differences in CPR and EMPs levels between the two groups during treatment, at different time points, and the interaction between groups and time(P < 0.05). There was no significant difference in EMPs and CRP levels between the two groups before operation(P > 0.05). Compared with before operation, the levels of EMPs and CRP in the two groups were significantly increased at 1 day after operation, and decreased significantly at14 days after treatment(P < 0.05). The levels of EMPs and CRP in the observation group at 1 and 14 days after operation were significantly lower than those in the control group, and the differences were statistically significant(P < 0.05).Conclusion Atorvastatin Calcium can effectively improve myocardial microcirculation, reduce EMPs and CRP levels and protect endothelial cells in ACS patients after PCI, which is worthy of clinical promotion.
引文
[1]Rogacev KS,Heine GH,Silbernagel G,et al.PCSK9 Plasma Concentrations Are Independent of GFR and Do Not Predict Cardiovascular Events in Patients with Decreased GFR[J].PLo S One,2016,11(1):14-15.
[2]Lu J,Liu F,Chen F,et al.Amlodipine and atorvastatin improve ventricular hypertrophy and diastolic function via inhibiting TNF-α,IL-1βand NF-κB inflammatory cytokine networks in elderly spontaneously hypertensive rats[J]Biomed Pharmacother,2016,83:330-339.
[3]Wang T,Li C,Deng W,et al.Influence of Atorvastatin/Probucol Combination on Blood Lipid and Serum C-Reactive Protein Levels in Patients with Cerebral Infarction[J]Trop J Pharm Res,2016,14(12):23-24.
[4]Rong L,Chen LZ,Zhao SP,et al.Inflammation Activation Contributes to Adipokine Imbalance in Patients with A-cute Coronary Syndrome[J].PLo S One,2016,11(3):16-19.
[5]Trial J,Cieslik KA,Entman ML.Phosphocholine-containing ligands direct CRP induction of M2 macrophage polarization independent of T cell polarization:Implication for chronic inflammatory states[J].Immun Inflamm Dis,2016,4(3):274-288.
[6]吴学华,曹光恒,杨剑,等.阿托伐他汀对急性冠状动脉综合征患者血管内皮功能和心肌损伤及心功能指标的影响[J].中华高血压杂志,2017,25(10):974-977.
[7]中华医学会心血管病学分会介入心脏病学组.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.
[8]洪涛.冠状动脉TIMI血流分级[J].中国介入心脏病学杂志,2003,11(3):134-135.
[9]王欢欢,袁晋青.急性冠状动脉综合征特殊人群的抗栓治疗新进展[J].中国循环杂志,2016,31(9):918-920.
[10]丁胜华,仵淑娟,郑立娇.不同剂量阿托伐他汀预处理对经皮冠状动脉介入治疗患者的保护作用[J].中国药房,2017,28(35):4987-4989.
[11]赵春勇,高筱红,金洪珍,等.不同他汀类药物联合比伐卢定对急性心梗患者PCI术后心肌功能、血凝状态及炎症因子水平的影响[J].海南医学,2016,27(23):3838-3840.
[12]林永忠,孙长凯,肖昭扬,等.不同疗程阿托伐他汀对脑梗死患者血脂和神经功能缺损程度的影响[J].中国临床康复,2006,10(20):28-31.
[13]肖亚利,王金艳,孟祥茹,等.不同剂量阿托伐他汀对急性冠脉综合征PCI术后血清炎症因子和心血管事件的影响[J].海南医学,2016,27(10):1593-1596.
[14]杨丽,刘寅,王树峰,等.普罗布考联合阿托伐他汀对ACS患者PCI术后ox-LDL及Lp-PLA2水平的影响[J].天津医药,2017,45(1):47-50.
[15]朱晓刚,王丽岳,任浩进,等.hs-CRP水平对急性冠状动脉综合征患者PCI术后肾功能损害的影响及阿托伐他汀的干预效果[J].中国循证心血管医学杂志,2016,8(10):1230-1233.
[16]董丽君,洪子惠.负荷量加高维持量的阿托伐他汀在ACS患者介入治疗后的临床应用效果[J].中国循证心血管医学杂志,2016,8(4):474-476.
[17]徐姗姗,高琴,应佐华,等.不同剂量阿托伐他汀对ACS征患者PCI术后血清c Tn I、NT-pro BNP及心肌酶谱的影响[J].疑难病杂志,2017,16(12):1201-1204.
[18]吕诚,王学惠,张永春.不同剂量阿托伐他汀钙对急性冠脉综合征患者PCI术后围术期血清IL-33及s ST2的影响[J].世界临床医学,2016,10(10):12-13.
[19]黄兴红,杨永曜.负荷量阿托伐他汀对急性冠脉综合征经皮冠脉介入术治疗患者心肌灌注、炎症反应及内皮功能的影响[J].中国老年学杂志,2016,36(8):1851-1852.
[20]彭辉兵,欧阳繁,唐强.负荷剂量阿托伐他汀预处理对心绞痛患者PCI后微循环的影响[J].心血管康复医学杂志,2016,25(4):421-424.
[2]Lu J,Liu F,Chen F,et al.Amlodipine and atorvastatin improve ventricular hypertrophy and diastolic function via inhibiting TNF-α,IL-1βand NF-κB inflammatory cytokine networks in elderly spontaneously hypertensive rats[J]Biomed Pharmacother,2016,83:330-339.
[3]Wang T,Li C,Deng W,et al.Influence of Atorvastatin/Probucol Combination on Blood Lipid and Serum C-Reactive Protein Levels in Patients with Cerebral Infarction[J]Trop J Pharm Res,2016,14(12):23-24.
[4]Rong L,Chen LZ,Zhao SP,et al.Inflammation Activation Contributes to Adipokine Imbalance in Patients with A-cute Coronary Syndrome[J].PLo S One,2016,11(3):16-19.
[5]Trial J,Cieslik KA,Entman ML.Phosphocholine-containing ligands direct CRP induction of M2 macrophage polarization independent of T cell polarization:Implication for chronic inflammatory states[J].Immun Inflamm Dis,2016,4(3):274-288.
[6]吴学华,曹光恒,杨剑,等.阿托伐他汀对急性冠状动脉综合征患者血管内皮功能和心肌损伤及心功能指标的影响[J].中华高血压杂志,2017,25(10):974-977.
[7]中华医学会心血管病学分会介入心脏病学组.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.
[8]洪涛.冠状动脉TIMI血流分级[J].中国介入心脏病学杂志,2003,11(3):134-135.
[9]王欢欢,袁晋青.急性冠状动脉综合征特殊人群的抗栓治疗新进展[J].中国循环杂志,2016,31(9):918-920.
[10]丁胜华,仵淑娟,郑立娇.不同剂量阿托伐他汀预处理对经皮冠状动脉介入治疗患者的保护作用[J].中国药房,2017,28(35):4987-4989.
[11]赵春勇,高筱红,金洪珍,等.不同他汀类药物联合比伐卢定对急性心梗患者PCI术后心肌功能、血凝状态及炎症因子水平的影响[J].海南医学,2016,27(23):3838-3840.
[12]林永忠,孙长凯,肖昭扬,等.不同疗程阿托伐他汀对脑梗死患者血脂和神经功能缺损程度的影响[J].中国临床康复,2006,10(20):28-31.
[13]肖亚利,王金艳,孟祥茹,等.不同剂量阿托伐他汀对急性冠脉综合征PCI术后血清炎症因子和心血管事件的影响[J].海南医学,2016,27(10):1593-1596.
[14]杨丽,刘寅,王树峰,等.普罗布考联合阿托伐他汀对ACS患者PCI术后ox-LDL及Lp-PLA2水平的影响[J].天津医药,2017,45(1):47-50.
[15]朱晓刚,王丽岳,任浩进,等.hs-CRP水平对急性冠状动脉综合征患者PCI术后肾功能损害的影响及阿托伐他汀的干预效果[J].中国循证心血管医学杂志,2016,8(10):1230-1233.
[16]董丽君,洪子惠.负荷量加高维持量的阿托伐他汀在ACS患者介入治疗后的临床应用效果[J].中国循证心血管医学杂志,2016,8(4):474-476.
[17]徐姗姗,高琴,应佐华,等.不同剂量阿托伐他汀对ACS征患者PCI术后血清c Tn I、NT-pro BNP及心肌酶谱的影响[J].疑难病杂志,2017,16(12):1201-1204.
[18]吕诚,王学惠,张永春.不同剂量阿托伐他汀钙对急性冠脉综合征患者PCI术后围术期血清IL-33及s ST2的影响[J].世界临床医学,2016,10(10):12-13.
[19]黄兴红,杨永曜.负荷量阿托伐他汀对急性冠脉综合征经皮冠脉介入术治疗患者心肌灌注、炎症反应及内皮功能的影响[J].中国老年学杂志,2016,36(8):1851-1852.
[20]彭辉兵,欧阳繁,唐强.负荷剂量阿托伐他汀预处理对心绞痛患者PCI后微循环的影响[J].心血管康复医学杂志,2016,25(4):421-424.