尼可地尔联合氯吡格雷治疗冠心病患者的效果及对血清Lp(a)、CX3CL1水平的影响
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摘要
目的探究尼可地尔联合氯吡格雷治疗冠心病患者的效果及对血清脂蛋白(a)[Lp(a)]、CX3CL1水平的影响。方法冠心病患者90例随机分为对照组和观察组。对照组使用尼可地尔治疗,观察组在对照组基础上联合氯吡格雷治疗。比较2组治疗后的临床疗效和不良反应发生情况。检测比较治疗前后2组患者的心功能指标[左心室射血分数(LVEF)、左心室舒张末期内径(LVEDD)]、心电图指标(ST段压低发生次数、ST段压低时间)、血清Lp(a)、CX3CL1水平。结果观察组的有效率显著高于对照组(P<0.05)。治疗后2组心功能指标和心电图指标均得到显著的改善(P<0.05),治疗后观察组的LVEF均显著高于对照组,LVEDD显著低于对照组(P<0.05);治疗后观察组ST段压低发生次数及ST段压低时间均显著低于对照组(P<0.05)。治疗前2组血清CX3CL1、Lp(a)差异无统计学意义(P>0.05),治疗后均显著降低(P<0.05),治疗后观察组血清CX3CL1、Lp(a)均显著低于对照组(P<0.05)。2组的不良反应发生情况差异无统计学意义(P>0.05)。结论尼可地尔联合氯吡格雷,对冠心病具有更好的临床疗效,可更好的改善心脏功能并减少心电图ST段异常。同时联合用药可更有效的降低CX3CL1以及Lp(a)水平,提示联合治疗具有更好的预后。
Objective To investigate the therapeutic effects of nicorandil combined with clopidogrel on coronary heart disease(CHD) and their effects on the serum levels of Lp(a) and CX3 CL1 of patients with CHD.Methods A total of 90 patients with CHD who were tyreated in our hospital from March 2017 to March 2018 were randomly divided into control group and observation group.The patients in control group were treated by nicorandil,however,the patients in observation group,on the basis of control group, were treated by clopidogrel.The clinical efficacy and adverse reactions after treatment were observed and compared between the two groups.The cardiac function indexes including gram index, LVEF,LVEDD,ECG indexes including the frequency of ST segment depression and ST segment depression time as well as the serum levels Lp(a) and CX3 CL1 before and after treatment were observed and compared between the two grousp. Results The effective rate in observation group was significantly higher than that in control group(P<0.05).After treatment,the cardiac function indexes and ECG indexes were significantly improved in both groups(P<0.05).After treatment,the LVEF in observation group was significantly higher than that in control group,however, the LVEDD was significantly lower than that in control group(P<0.05).After treatment,the frequency of ST-segment depression and the ST-segment depression time in observation group were significantly lower than those in control group(P<0.05).Before treatment there were no significant differences in the serum levels of CX3 CL1 and Lp(a) between the two groups(P>0.05).After treatment,the serum levels of CX3 CL1 and Lp(a) were significantly decreased in both groups,moreover,which in observation group were significantly lower than those in control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The nicorandil combined with clopidogrel has a better clinical curative effects on coronary heart disease,which can improve cardiac function and reduce ECG ST segment abnormalities.Moreover the combination treatment can effectively reduce the serum levels of CX3 CL1 and Lp(a),which suggests that the combination treatment can obtain a better prognosis.
Objective To investigate the therapeutic effects of nicorandil combined with clopidogrel on coronary heart disease(CHD) and their effects on the serum levels of Lp(a) and CX3 CL1 of patients with CHD.Methods A total of 90 patients with CHD who were tyreated in our hospital from March 2017 to March 2018 were randomly divided into control group and observation group.The patients in control group were treated by nicorandil,however,the patients in observation group,on the basis of control group, were treated by clopidogrel.The clinical efficacy and adverse reactions after treatment were observed and compared between the two groups.The cardiac function indexes including gram index, LVEF,LVEDD,ECG indexes including the frequency of ST segment depression and ST segment depression time as well as the serum levels Lp(a) and CX3 CL1 before and after treatment were observed and compared between the two grousp. Results The effective rate in observation group was significantly higher than that in control group(P<0.05).After treatment,the cardiac function indexes and ECG indexes were significantly improved in both groups(P<0.05).After treatment,the LVEF in observation group was significantly higher than that in control group,however, the LVEDD was significantly lower than that in control group(P<0.05).After treatment,the frequency of ST-segment depression and the ST-segment depression time in observation group were significantly lower than those in control group(P<0.05).Before treatment there were no significant differences in the serum levels of CX3 CL1 and Lp(a) between the two groups(P>0.05).After treatment,the serum levels of CX3 CL1 and Lp(a) were significantly decreased in both groups,moreover,which in observation group were significantly lower than those in control group(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion The nicorandil combined with clopidogrel has a better clinical curative effects on coronary heart disease,which can improve cardiac function and reduce ECG ST segment abnormalities.Moreover the combination treatment can effectively reduce the serum levels of CX3 CL1 and Lp(a),which suggests that the combination treatment can obtain a better prognosis.
引文
1 EAS Task Force for Prevention of Coronary Heart Disease.Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia-NEJM.New England Journal of Medicine,2014,5:1301-1307.
2 Pang Z,Zhao W,Yao Z.Cardioprotective effects of nicorandil on coronary heart disease patients undergoing elective percutaneous coronary intervention.Medical Science Monitor International Medical Journal of Experimental & Clinical Research,2017,15:2924-2930.
3 Liu T,Yin T,Li Y,et al.CYP2C19 polymorphisms and coronary heart disease risk factors synergistically impact clopidogrel response variety after percutaneous coronary intervention.Coronary Artery Disease,2014,25:593-597.
4 Jin SG,Chen GL,Yang SL,et al.Gene-gene interactions among CX3CL1,LEPR and IL-6 related to coronary artery disease in Chinese Han population.International Journal of Clinical & Experimental Pathology,2015,8:5968-5973.
5 Raal FJ,Giugliano RP,Sabatine MS,et al.PCSK9 inhibition-mediated reduction in Lp(a) ith evolocumab:an analysis of 10 clinical trials and the LDL receptor's role.Journal of Lipid Research,2016,57:1086-1096.
6 沈迎,张奇,沈卫峰.美国和欧洲稳定性冠心病诊治指南解读.中华心血管病杂志,2014,42:70-72.
7 王波,王临池,赵翼洪,等.2009-2013年苏州20岁及以上居民冠心病发病率变化趋势及类型分析.中国全科医学,2015,25:2952-2956.
8 高彦娜,孙同文,张晓娟,等.冠心病药物、介入治疗和冠脉搭桥术的长期疗效对比分析.河南医学研究,2016,25:619-622.
9 王璐璐,韩冰.尼可地尔和卡维地洛联合治疗冠心病心肌缺血的临床研究.岭南心血管病杂志,2016,22:653-656.
10 Angiolillo DJ,Jakubowski JA,Ferreiro JL,et al.Impaired responsiveness to the platelet P2Y12 receptor antagonist clopidogrel in patients with type 2 diabetes and coronary artery disease.Journal of the American College of Cardiology,2014,64:1005-1014.
11 邢春玲.慢性稳定性冠心病不同治疗方法的预后比较.中国现代药物应用,2016,10:207-208.
12 Imhof A,Rothenbacher D,Khuseyinova N,et al.Plasma lipoprotein Lp(a),markers of haemostasis and inflammation,and risk and severity of coronary heart disease.Eur J Cardiovasc Prev Rehabil,2015,10:362-370.
13 Martínezhervás S,Vinué á,Núňez L,et al.Insulin resistance aggravates atherosclerosis by reducing vascular smooth muscle cell survival and increasing CX3CL1/CX3CR1 axis.Cardiovascular Research,2014,103:324-336.
14 Stavros Apostolakis,Demetrios Spandidos.Chemokines and atheroscler- osis:focus on the CX3CL1/CX3CR1 pathway.Acta Pharmacol Sin,2013,34:1251-1256.
15 Yang J,Liu C,Zhang L,et al.Intensive atorvastatin therapy attenuates the inflammatory responses in monocytes of patients with unstable angina undergoing percutaneous coronary intervention via peroxisome proliferator-activated receptor γ activation.Inflammation,2015,38:1415-1423.
16 郑丽芳,潘春联,梅元武.氯吡格雷在急性脑梗死中的抗炎作用.中国老年学杂志,2014,34:5384-5386.
2 Pang Z,Zhao W,Yao Z.Cardioprotective effects of nicorandil on coronary heart disease patients undergoing elective percutaneous coronary intervention.Medical Science Monitor International Medical Journal of Experimental & Clinical Research,2017,15:2924-2930.
3 Liu T,Yin T,Li Y,et al.CYP2C19 polymorphisms and coronary heart disease risk factors synergistically impact clopidogrel response variety after percutaneous coronary intervention.Coronary Artery Disease,2014,25:593-597.
4 Jin SG,Chen GL,Yang SL,et al.Gene-gene interactions among CX3CL1,LEPR and IL-6 related to coronary artery disease in Chinese Han population.International Journal of Clinical & Experimental Pathology,2015,8:5968-5973.
5 Raal FJ,Giugliano RP,Sabatine MS,et al.PCSK9 inhibition-mediated reduction in Lp(a) ith evolocumab:an analysis of 10 clinical trials and the LDL receptor's role.Journal of Lipid Research,2016,57:1086-1096.
6 沈迎,张奇,沈卫峰.美国和欧洲稳定性冠心病诊治指南解读.中华心血管病杂志,2014,42:70-72.
7 王波,王临池,赵翼洪,等.2009-2013年苏州20岁及以上居民冠心病发病率变化趋势及类型分析.中国全科医学,2015,25:2952-2956.
8 高彦娜,孙同文,张晓娟,等.冠心病药物、介入治疗和冠脉搭桥术的长期疗效对比分析.河南医学研究,2016,25:619-622.
9 王璐璐,韩冰.尼可地尔和卡维地洛联合治疗冠心病心肌缺血的临床研究.岭南心血管病杂志,2016,22:653-656.
10 Angiolillo DJ,Jakubowski JA,Ferreiro JL,et al.Impaired responsiveness to the platelet P2Y12 receptor antagonist clopidogrel in patients with type 2 diabetes and coronary artery disease.Journal of the American College of Cardiology,2014,64:1005-1014.
11 邢春玲.慢性稳定性冠心病不同治疗方法的预后比较.中国现代药物应用,2016,10:207-208.
12 Imhof A,Rothenbacher D,Khuseyinova N,et al.Plasma lipoprotein Lp(a),markers of haemostasis and inflammation,and risk and severity of coronary heart disease.Eur J Cardiovasc Prev Rehabil,2015,10:362-370.
13 Martínezhervás S,Vinué á,Núňez L,et al.Insulin resistance aggravates atherosclerosis by reducing vascular smooth muscle cell survival and increasing CX3CL1/CX3CR1 axis.Cardiovascular Research,2014,103:324-336.
14 Stavros Apostolakis,Demetrios Spandidos.Chemokines and atheroscler- osis:focus on the CX3CL1/CX3CR1 pathway.Acta Pharmacol Sin,2013,34:1251-1256.
15 Yang J,Liu C,Zhang L,et al.Intensive atorvastatin therapy attenuates the inflammatory responses in monocytes of patients with unstable angina undergoing percutaneous coronary intervention via peroxisome proliferator-activated receptor γ activation.Inflammation,2015,38:1415-1423.
16 郑丽芳,潘春联,梅元武.氯吡格雷在急性脑梗死中的抗炎作用.中国老年学杂志,2014,34:5384-5386.