不同剂量辛伐他汀对急性心肌梗死早期血脂及基质金属蛋白酶的影响
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摘要
目的 对120例急性心肌梗死患者进行临床研究,观察不同剂量辛伐他汀治疗急性心肌梗死患者2周,监测其血脂及基质金属蛋白酶-1(MMP-1)的变化,以了解急性心肌梗死后早期的血脂的动态变化以及早期应用不同剂量的辛伐他汀治疗对血脂动态改变及斑块稳定的影响,为急性心肌梗死后早期应用较大剂量的他汀类药物提供临床依据。
方法 120例急性心肌梗死患者随机、单盲分为对照组(未服用任何调脂药物)和辛伐他汀(舒降之)(20mg/d)组及辛伐他汀(40mg/d)组治疗,对照组39例,予以常规治疗,不用任何调脂药物;辛伐他汀(20mg/d)组40例,予以常规治疗加辛伐他汀20mg/d;辛伐他汀(40mg/d)组41例,予以常规治疗加辛伐他汀40mg/d,治疗前及治疗3天、7天、14天后抽血检查血脂、肝、肾功能、心肌酶及MMP-1等指标。观察住院期间主要心血管事件、心功能、心律失常及药物不良反应。
结果 1) 急性心肌梗死早期血脂变化情况:血清总胆固醇(TC)发病后3天较第一天下降3%,第7、14天分别上升1.3%、5.3%;低密度脂蛋白胆固醇(LDL-C)发病后3天较第一天下降3%,第7、14天分别上升15%、21%;甘油三酯(TG)发病后3、7、14天较第一天分别上升15%、23%、26%;高密度脂蛋白胆固醇(HDL-C)发病后3、7、14天较第一天分别下降5.8%、12%、4.1%。2) 辛伐他汀20mg/d组血脂变化情况:治疗后3、7、14天血清TC水平分别较治疗前下降4.3%、4.3%、1.8%:治疗后3、7、14天血清LDL-C水平分别较治疗前下降15%、10%、4.1%:治疗后3、7、14天血清TG水平分别较治疗前上升14%、10%、22%;治疗后3、7、14天血清HDL-C水平分别较治疗前下降4.1%、11%、4.9%。3) 辛伐他汀40mg/d组血脂变化情况:治疗后3、7、14天血清TC水平分别较治疗前下降7.7%、13%、10%;治疗后3、7、14天血清LDL-C水平分别较治疗前下降18%、19%、
Objective To observe the influence of two different doses simvastatin on serum matrix metalloproteinases-1 and lipid in patients of acute myocardial infarction(AMI) in early stage. To investigate the change of serum lipid of AMI in early stage and the influence of two different doses simvastatin on lipid and stability of plaque in order to provide clinic evidence for uasage of higher dose statins in early stage of AMI. Methods 120 consecutive patients with AMI were divided into three groups randomly: group 1( n = 41) was given 40mg/d simvastatin at night, group 2 ( n = 40 ) was given 20mg/d simvastatin , control group ( n =39) was no lipid-lowering drugs. The serum levels of MMP-1 and serum lipid before and after treatment 3、 7、 14 day were detected. The cardiovascular events, heart function ,arrhythmia and drug adverse reaction were recorded.Results 1)The lipids of change in control group:compared to those before treatment, the level of serum TC decreased 3% on the 3rd day, increased respectively 1.3%,5.3% on the 7~(th) and 14~(th) day; the level of serum LDL-C decreased 3% on the 3~(rd) day, increased respectively 15%,21% on the 7~(th) and 14~(th) day; the level of TG increased respectively 15%,23%,26%; the level of HDL-C decreased respectively 5.8%,12%,4.1%.2) The lipids change in simvastatin 20mg/d group(group 2): compared to those before treatment, the level of serum TC decreased respectively 4.3%,4.3%,1.8% on the 3~(rd) ,7~(th) ,14~(th) day; the level of serum LDL-C decreased respectively 15%,10%,4.1% on the 3~(rd) , 7~(th) , 14~(th) day; the level of TG increased respectively 14%,10%,22%; the level of HDL-C decreased respectively
4.1%,11%,4.9%.3) The lipids change in simvastatin 40mg/d group(group 1): compared to those before treatment, the level of serum TC decreased respectively 7.7%, 13%, 10% on the 3rd ,7lh ,14th day; the level of serum LDL-C decreased respectively 18%,19%,23% on the 3rd , 7lh , 14th day; the level of TG increased respectively 1.3%,9.9%,12.5%; the level of HDL-C decreased respectively 5.5%,10%,6.3%.4) Compared to those before treatment, the level of serum levels of MMP-1 increased respectively 2.5%,16%,8.8% in the control group.There was not significant difference after treatment (P > 0.05) .5) Compared to those before treatment, the level of serum levels of MMP-1 decreased respectively 21%,28%,30% in the group 2.There was significant difference after treatment (P< 0.05) .6) Compared to those before treatment, the level of serum levels of MMP-1 decreased respectively 27%,35%,40% in the group 1.There was significant difference after treatment (/><0.05) .7) Comparing with group 2 there was relatively lower levels of MMP-1 on the 7th and 14th day(P<0.05) .8) In group 2 the decrease of MMP-1 had no correlation to the percentage of TC decreased(3rd r = 0.137, P = 0.22; 7th r = 0.14, P = 0.22; 14th r = 0.104, P=0.36).9) In group 2 the decrease of MMP-1 had no correlation to the percentage of LDL-C decreased(3rd r = 0.22, P = 0.06; 7th r = 0.21, P = 0.06; 14th r = 0.104, P = 0.36). 10 ) In group 1 the decrease of MMP-1 had no correlation to the percentage of TC decreased(3rd r = 0.08, P = 0.479; 7th r = 0.21, P = 0.07; 14th r = 0.19, P = 0.09).ll) In group 1 the decrease of MMP-1 had no correlation to the percentage of LDL-C decreased(3rd r = 0.07, P= 0.56; 7th r = 0.17, P = 0.13).On the 14th day,the decrease of MMP-1 had correlation to the percentage the LDL-C had decreased(r = 0.22, P = 0.048).Conclusion 1) There is a dynamic change in the serum lipid in the patients of AMI in early stage, it seems decrease before increase. The total serum cholesterol and low density lipoprotein start decreasing soon after AMI and the lowest at 3rd day then increase slowly. The HDL-C was decreasing and the TG was increasing. 2) The use of different dose simvastatin can delay or depress the increase of LDL-C. Simvastatin 20mg/d can not depress it's increase but had lower significantly level than control group. Simvastatin 40mg/d can decrease significantly level of LDL-C and depress the decrease of HDL-C.The
decreased level of LDL-C was associated with the dose of simvastatin. 3) The earlyuse of statins decreased significantly level of MMP-1. The level of MMP-1 decreasedhad no correlation to the level of LDL-C and TC.It was associated with the dose ofsimvastatin.4) The use of higher dose simvastatin in the patients of AMI in earlystage may modulate lipids and benefit to atherosclerotic plaque stabilization .
方法 120例急性心肌梗死患者随机、单盲分为对照组(未服用任何调脂药物)和辛伐他汀(舒降之)(20mg/d)组及辛伐他汀(40mg/d)组治疗,对照组39例,予以常规治疗,不用任何调脂药物;辛伐他汀(20mg/d)组40例,予以常规治疗加辛伐他汀20mg/d;辛伐他汀(40mg/d)组41例,予以常规治疗加辛伐他汀40mg/d,治疗前及治疗3天、7天、14天后抽血检查血脂、肝、肾功能、心肌酶及MMP-1等指标。观察住院期间主要心血管事件、心功能、心律失常及药物不良反应。
结果 1) 急性心肌梗死早期血脂变化情况:血清总胆固醇(TC)发病后3天较第一天下降3%,第7、14天分别上升1.3%、5.3%;低密度脂蛋白胆固醇(LDL-C)发病后3天较第一天下降3%,第7、14天分别上升15%、21%;甘油三酯(TG)发病后3、7、14天较第一天分别上升15%、23%、26%;高密度脂蛋白胆固醇(HDL-C)发病后3、7、14天较第一天分别下降5.8%、12%、4.1%。2) 辛伐他汀20mg/d组血脂变化情况:治疗后3、7、14天血清TC水平分别较治疗前下降4.3%、4.3%、1.8%:治疗后3、7、14天血清LDL-C水平分别较治疗前下降15%、10%、4.1%:治疗后3、7、14天血清TG水平分别较治疗前上升14%、10%、22%;治疗后3、7、14天血清HDL-C水平分别较治疗前下降4.1%、11%、4.9%。3) 辛伐他汀40mg/d组血脂变化情况:治疗后3、7、14天血清TC水平分别较治疗前下降7.7%、13%、10%;治疗后3、7、14天血清LDL-C水平分别较治疗前下降18%、19%、
Objective To observe the influence of two different doses simvastatin on serum matrix metalloproteinases-1 and lipid in patients of acute myocardial infarction(AMI) in early stage. To investigate the change of serum lipid of AMI in early stage and the influence of two different doses simvastatin on lipid and stability of plaque in order to provide clinic evidence for uasage of higher dose statins in early stage of AMI. Methods 120 consecutive patients with AMI were divided into three groups randomly: group 1( n = 41) was given 40mg/d simvastatin at night, group 2 ( n = 40 ) was given 20mg/d simvastatin , control group ( n =39) was no lipid-lowering drugs. The serum levels of MMP-1 and serum lipid before and after treatment 3、 7、 14 day were detected. The cardiovascular events, heart function ,arrhythmia and drug adverse reaction were recorded.Results 1)The lipids of change in control group:compared to those before treatment, the level of serum TC decreased 3% on the 3rd day, increased respectively 1.3%,5.3% on the 7~(th) and 14~(th) day; the level of serum LDL-C decreased 3% on the 3~(rd) day, increased respectively 15%,21% on the 7~(th) and 14~(th) day; the level of TG increased respectively 15%,23%,26%; the level of HDL-C decreased respectively 5.8%,12%,4.1%.2) The lipids change in simvastatin 20mg/d group(group 2): compared to those before treatment, the level of serum TC decreased respectively 4.3%,4.3%,1.8% on the 3~(rd) ,7~(th) ,14~(th) day; the level of serum LDL-C decreased respectively 15%,10%,4.1% on the 3~(rd) , 7~(th) , 14~(th) day; the level of TG increased respectively 14%,10%,22%; the level of HDL-C decreased respectively
4.1%,11%,4.9%.3) The lipids change in simvastatin 40mg/d group(group 1): compared to those before treatment, the level of serum TC decreased respectively 7.7%, 13%, 10% on the 3rd ,7lh ,14th day; the level of serum LDL-C decreased respectively 18%,19%,23% on the 3rd , 7lh , 14th day; the level of TG increased respectively 1.3%,9.9%,12.5%; the level of HDL-C decreased respectively 5.5%,10%,6.3%.4) Compared to those before treatment, the level of serum levels of MMP-1 increased respectively 2.5%,16%,8.8% in the control group.There was not significant difference after treatment (P > 0.05) .5) Compared to those before treatment, the level of serum levels of MMP-1 decreased respectively 21%,28%,30% in the group 2.There was significant difference after treatment (P< 0.05) .6) Compared to those before treatment, the level of serum levels of MMP-1 decreased respectively 27%,35%,40% in the group 1.There was significant difference after treatment (/><0.05) .7) Comparing with group 2 there was relatively lower levels of MMP-1 on the 7th and 14th day(P<0.05) .8) In group 2 the decrease of MMP-1 had no correlation to the percentage of TC decreased(3rd r = 0.137, P = 0.22; 7th r = 0.14, P = 0.22; 14th r = 0.104, P=0.36).9) In group 2 the decrease of MMP-1 had no correlation to the percentage of LDL-C decreased(3rd r = 0.22, P = 0.06; 7th r = 0.21, P = 0.06; 14th r = 0.104, P = 0.36). 10 ) In group 1 the decrease of MMP-1 had no correlation to the percentage of TC decreased(3rd r = 0.08, P = 0.479; 7th r = 0.21, P = 0.07; 14th r = 0.19, P = 0.09).ll) In group 1 the decrease of MMP-1 had no correlation to the percentage of LDL-C decreased(3rd r = 0.07, P= 0.56; 7th r = 0.17, P = 0.13).On the 14th day,the decrease of MMP-1 had correlation to the percentage the LDL-C had decreased(r = 0.22, P = 0.048).Conclusion 1) There is a dynamic change in the serum lipid in the patients of AMI in early stage, it seems decrease before increase. The total serum cholesterol and low density lipoprotein start decreasing soon after AMI and the lowest at 3rd day then increase slowly. The HDL-C was decreasing and the TG was increasing. 2) The use of different dose simvastatin can delay or depress the increase of LDL-C. Simvastatin 20mg/d can not depress it's increase but had lower significantly level than control group. Simvastatin 40mg/d can decrease significantly level of LDL-C and depress the decrease of HDL-C.The
decreased level of LDL-C was associated with the dose of simvastatin. 3) The earlyuse of statins decreased significantly level of MMP-1. The level of MMP-1 decreasedhad no correlation to the level of LDL-C and TC.It was associated with the dose ofsimvastatin.4) The use of higher dose simvastatin in the patients of AMI in earlystage may modulate lipids and benefit to atherosclerotic plaque stabilization .
引文
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