不同剂量阿托伐他汀对不稳定型心绞痛行经皮冠脉介入术患者相关指标的影响
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摘要
目的探讨不同剂量阿托伐他汀对不稳定型心绞痛(UAP)行经皮冠脉介入术(PCI)患者血脂代谢指标、同型半胱氨酸(Hcy)水平及心功能指标的影响。方法将150例行PCI治疗的UAP患者随机分为A、B组各75例,分别采用常规剂量(20 mg)及大剂量阿托伐他汀(40 mg)治疗。比较2组治疗前及治疗3个月血脂指标、高敏C反应蛋白(hs-CRP)、肌钙蛋白Ⅰ(c TnI)、Hcy水平,以及左室射血分数(LVEF)、左室舒张末期内径(LVDD)、心排出量(CO)、每搏量(SV)的变化,比较2组不良反应及随访1年不良事件发生情况。结果治疗3个月,2组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、hs-CRP、c TnI、Hcy均显著降低,B组降低幅度显著大于A组(P <0. 05)。治疗3个月,2组LVEF、SV、CO均较治疗前显著上升,LVDD显著降低(P <0. 05),B组LVEF、SV、CO显著高于A组,LVDD显著低于A组(P <0. 05)。A、B组不良反应发生情况与随访不良事件发生情况对比,差异无统计学意义(P> 0. 05)。结论大剂量阿托伐他汀可调节UAP行PCI术患者的血脂代谢指标水平,减轻机体炎症反应程度,促进心功能的恢复。
Objective To explore the effects of different doses of atorvastatin on the blood lipid metabolism indexes,homocysteine( Hcy) level and cardiac function indexes in unstable angina pectoris( UAP) patients treated by percutaneous coronary intervention( PCI). Methods A total of150 UAP patients treated by PCI were randomly divided into group A and group B,with 75 cases in each group. Group A and group B were treated with routine dose( 20 mg) and large dose( 40 mg) of atorvastatin respectively. The changes of blood lipid indexes,high sensitivity C-reactive protein( hs-CRP) and troponin Ⅰ( cTnI) and Hcy levels,and left ventricular ejection fraction( LVEF),left ventricular end-diastolic diameter( LVDD),cardiac output( CO) and stroke volume( SV) before treatment and 3 months after treatment were compared between the two groups. The adverse reactions and adverse events within 1-year follow-up were compared as well. Results After 3 months of treatment,total cholesterol( TC),low density lipoprotein cholesterol( LDL-C),hs-CRP,cTnI and Hcy levels in both groups significantly decreased,and the reduction extents of these indexes in group B were significantly greater than those in group A( P < 0. 05). After 3 months of treatment,LVEF,SV and CO in both groups increased significantly and LVDD decreased significantly( P < 0. 05),and LVEF,SV and CO in group B were significantly higher than those in group A,while LVDD was significantly lower than group A( P < 0. 05). There were no significant differences in adverse reactions and adverse events within 1-year follow-up between two groups( P > 0. 05). Conclusion High-dose atorvastatin can regulate the level of blood lipid metabolism indexes in UAP patients with PCI,alleviate the degree of inflammation and promote the recovery of cardiac function.
Objective To explore the effects of different doses of atorvastatin on the blood lipid metabolism indexes,homocysteine( Hcy) level and cardiac function indexes in unstable angina pectoris( UAP) patients treated by percutaneous coronary intervention( PCI). Methods A total of150 UAP patients treated by PCI were randomly divided into group A and group B,with 75 cases in each group. Group A and group B were treated with routine dose( 20 mg) and large dose( 40 mg) of atorvastatin respectively. The changes of blood lipid indexes,high sensitivity C-reactive protein( hs-CRP) and troponin Ⅰ( cTnI) and Hcy levels,and left ventricular ejection fraction( LVEF),left ventricular end-diastolic diameter( LVDD),cardiac output( CO) and stroke volume( SV) before treatment and 3 months after treatment were compared between the two groups. The adverse reactions and adverse events within 1-year follow-up were compared as well. Results After 3 months of treatment,total cholesterol( TC),low density lipoprotein cholesterol( LDL-C),hs-CRP,cTnI and Hcy levels in both groups significantly decreased,and the reduction extents of these indexes in group B were significantly greater than those in group A( P < 0. 05). After 3 months of treatment,LVEF,SV and CO in both groups increased significantly and LVDD decreased significantly( P < 0. 05),and LVEF,SV and CO in group B were significantly higher than those in group A,while LVDD was significantly lower than group A( P < 0. 05). There were no significant differences in adverse reactions and adverse events within 1-year follow-up between two groups( P > 0. 05). Conclusion High-dose atorvastatin can regulate the level of blood lipid metabolism indexes in UAP patients with PCI,alleviate the degree of inflammation and promote the recovery of cardiac function.
引文
[1]吴春风,胡柯.超短期强化他汀治疗对不稳定型心绞痛患者PCI术中无复流现象及血清hs-CRP的影响[J].山东医药,2016,56(17):71-72.
[2]张静怡,张博男,吕冰,等.强化他汀治疗对术后患者血脂和骨代谢指标及骨密度的影响[J].重庆医学,2015,44(21):2910-2912.
[3]郭筱燕,黄学成,王琦武.稳定型心绞痛患者冠状动脉介入治疗术前强化他汀治疗对心肌损伤的保护作用[J].广东医学,2014,35(18):2920-2923.
[4] Sardella G,Lucisano L,Mancone M,et al. Comparison of high reloading Rosuvastatin and Atorvastatin pretreatment in patients undergoing elective PCI to reduce the incidence of Myocardial periprocedural necrosis. The ROMA II trial[J].International Journal of Cardiology,2013,168(4):3715-3720.
[5] Giral P,Hansel B,Chapman J. Dual Lipid-Lowering Strategy With Ezetimibe and Atorvastatin on Coronary Plaque Regression After PCI:PRECISE-IVUS[J]. Journal of the American College of Cardiology,2016,67(2):234-235.
[6]黄琛,徐戈,吕静,等.强化剂量阿托伐他汀对不稳定型心绞痛患者经皮冠状动脉介入术围手术期炎症反应的影响[J].实用医学杂志,2017,34(6):24-27.
[7] Kucera M,Oravec S,Hirnerova E,et al. Effect of atorvastatin on low-density lipoprotein subpopulations and comparison between indicators of plasma atherogenicity:a pilot study[J].Angiology,2014,65(9):794-799.
[8] Su Q,Li L,Liu Y,et al. Effect of intensive atorvastatin therapy on periprocedural PDCD4 expression in CD4+T lymphocytes of patients with unstable angina undergoing percutaneous coronary intervention[J]. Cardiology,2014,127(3):169-175.
[9]侯王君,庄贺,薛一涛,等.应用中医传承辅助平台分析冠心病不稳定型心绞痛方剂的组方用药规律[J].中国药房,2017,28(32):4478-4482.
[10]朱勇,高孟秋,张美春,等.前列地尔联合单硝酸异山梨酯治疗不稳定型心绞痛的临床研究[J].中国临床药理学杂志,2016,32(15):1356-1358.
[11]郑容梅.优质护理在低分子肝素治疗不稳定型心绞痛的辅助干预效果观察[J].实用临床医药杂志,2016,20(2):4-7.
[12]赵庆霞,张秀梅,纪征,等.辛伐他汀联合通脉颗粒治疗不稳定型心绞痛的临床疗效及安全性评价[J].中国临床药理学杂志,2016,32(8):690-692.
[13]吴春风,胡柯.超短期强化他汀治疗对不稳定型心绞痛患者PCI术中无复流现象及血清hs-CRP的影响[J].山东医药,2016,56(17):71-72.
[14]尹成淑,孟晓萍,曹振东,等.丹红注射液对老年不稳定型心绞痛患者血浆Hcy及MMP-2水平的影响[J].山东医药,2016,56(22):46-47.
[15]李辉,赵凯.氨氯地平阿托伐他汀钙片治疗高血压合并冠心病的临床研究[J].实用药物与临床,2017,20(1):56-59.
[16]姬会春,刘军权,周燏,等.阿托伐他汀对人NK细胞杀伤结肠癌细胞的影响及其机制研究[J].中国免疫学杂志,2017,33(2):178-185.
[17]钟文津,杨炳昂,景香香,等.颈动脉粥样硬化患者外周血Th17、Treg比例及阿托伐他汀对其的影响[J].山东医药,2018,58(12):59-61.
[18]张涛,陈晖,黄家树,等.阿托伐他汀干预对大鼠炎性反应水平和心肌纤维化的影响[J].重庆医学,2017,46(30):4243-4246.
[19]孟哲,李凌.不同剂量阿托伐他汀对合并SAS的冠心病患者PCI术后的影响[J].实用医学杂志,2018,34(2):269-272,276.
[20]忠庆,黄维义.阿托伐他汀诱导血红素氧合酶1表达对血管内皮细胞抗炎症损伤能力的影响[J].山东医药,2017,57(17):34-36.
[2]张静怡,张博男,吕冰,等.强化他汀治疗对术后患者血脂和骨代谢指标及骨密度的影响[J].重庆医学,2015,44(21):2910-2912.
[3]郭筱燕,黄学成,王琦武.稳定型心绞痛患者冠状动脉介入治疗术前强化他汀治疗对心肌损伤的保护作用[J].广东医学,2014,35(18):2920-2923.
[4] Sardella G,Lucisano L,Mancone M,et al. Comparison of high reloading Rosuvastatin and Atorvastatin pretreatment in patients undergoing elective PCI to reduce the incidence of Myocardial periprocedural necrosis. The ROMA II trial[J].International Journal of Cardiology,2013,168(4):3715-3720.
[5] Giral P,Hansel B,Chapman J. Dual Lipid-Lowering Strategy With Ezetimibe and Atorvastatin on Coronary Plaque Regression After PCI:PRECISE-IVUS[J]. Journal of the American College of Cardiology,2016,67(2):234-235.
[6]黄琛,徐戈,吕静,等.强化剂量阿托伐他汀对不稳定型心绞痛患者经皮冠状动脉介入术围手术期炎症反应的影响[J].实用医学杂志,2017,34(6):24-27.
[7] Kucera M,Oravec S,Hirnerova E,et al. Effect of atorvastatin on low-density lipoprotein subpopulations and comparison between indicators of plasma atherogenicity:a pilot study[J].Angiology,2014,65(9):794-799.
[8] Su Q,Li L,Liu Y,et al. Effect of intensive atorvastatin therapy on periprocedural PDCD4 expression in CD4+T lymphocytes of patients with unstable angina undergoing percutaneous coronary intervention[J]. Cardiology,2014,127(3):169-175.
[9]侯王君,庄贺,薛一涛,等.应用中医传承辅助平台分析冠心病不稳定型心绞痛方剂的组方用药规律[J].中国药房,2017,28(32):4478-4482.
[10]朱勇,高孟秋,张美春,等.前列地尔联合单硝酸异山梨酯治疗不稳定型心绞痛的临床研究[J].中国临床药理学杂志,2016,32(15):1356-1358.
[11]郑容梅.优质护理在低分子肝素治疗不稳定型心绞痛的辅助干预效果观察[J].实用临床医药杂志,2016,20(2):4-7.
[12]赵庆霞,张秀梅,纪征,等.辛伐他汀联合通脉颗粒治疗不稳定型心绞痛的临床疗效及安全性评价[J].中国临床药理学杂志,2016,32(8):690-692.
[13]吴春风,胡柯.超短期强化他汀治疗对不稳定型心绞痛患者PCI术中无复流现象及血清hs-CRP的影响[J].山东医药,2016,56(17):71-72.
[14]尹成淑,孟晓萍,曹振东,等.丹红注射液对老年不稳定型心绞痛患者血浆Hcy及MMP-2水平的影响[J].山东医药,2016,56(22):46-47.
[15]李辉,赵凯.氨氯地平阿托伐他汀钙片治疗高血压合并冠心病的临床研究[J].实用药物与临床,2017,20(1):56-59.
[16]姬会春,刘军权,周燏,等.阿托伐他汀对人NK细胞杀伤结肠癌细胞的影响及其机制研究[J].中国免疫学杂志,2017,33(2):178-185.
[17]钟文津,杨炳昂,景香香,等.颈动脉粥样硬化患者外周血Th17、Treg比例及阿托伐他汀对其的影响[J].山东医药,2018,58(12):59-61.
[18]张涛,陈晖,黄家树,等.阿托伐他汀干预对大鼠炎性反应水平和心肌纤维化的影响[J].重庆医学,2017,46(30):4243-4246.
[19]孟哲,李凌.不同剂量阿托伐他汀对合并SAS的冠心病患者PCI术后的影响[J].实用医学杂志,2018,34(2):269-272,276.
[20]忠庆,黄维义.阿托伐他汀诱导血红素氧合酶1表达对血管内皮细胞抗炎症损伤能力的影响[J].山东医药,2017,57(17):34-36.