强化脂必泰治疗对血脂异常的冠心病中、高危患者炎症因子的影响及其安全性评估
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摘要
目的:评价强化脂必泰治疗对血脂异常的冠心病中高危患者炎症因子的影响并评估其临床安全性。
方法:选择我院2007年6月至2008年5月住院及门诊的冠心病中、高危患者240例,其中男性157例,女性83例,年龄在55-72岁;随机分为试验组120例(男79例,女41例)对照组120例(男78例,女42例)。试验组予以基本治疗十脂必泰胶囊480mg口服每日两次,对照组予基本治疗十阿托伐他汀10mg口服每日1次。(基本治疗:除降脂治疗以外,根据患者病情给予降压/降糖/其他治疗)。所有患者于治疗前及治疗后4周、8周分别检测血脂、心肌酶学、肝肾功能一次。所有患者于治疗前及治疗后8周分别检测hs-CRP、P-选择素、MMP-9、SICAM-1一次。
结果:两组治疗4周、8周后与治疗前比较TC、LDL-C显著下降(p＜0.05),HDL-C显著升高(p＜0.05);脂必泰组治疗4周、8周后与治疗前比较TG显著下降(P＜0.05),而阿托伐他汀组治疗4周与治疗前比较TG无显著下降(P＞0.05),治疗8周后TG显著下降(P＜0.05);两组治疗8周后hs-CRP、P-选择素、MMP-9、SICAM-1各炎症因子较治疗前均明显降低(p＜0.01),两组间比较差异无显著性(p＞0.05)。两组治疗前后肝肾功能、肌酶变化、肌病发生率,消化道反应发生率无统计学差异(p＞0.05)。
结论:强化脂必泰治疗除能有效调脂外,还能有效降低血脂异常的冠心病中、高危患者的炎症因子,且临床应用安全。
Objective: To evaluate the lipid lowing effects and the clinical safety of intensive therapy of Chinese medicine Zhibitai in patients with moderate and high risk of atherosclerosis.
Methods: 240 patients who were 55-72 year-old with moderate and high risk of atherosclerosis in our hospital from June 2007 to May 2008 were recruited. There were 157 male and 83 female among them. All the patients were randomly divided in to test group which was 120 people (79 male, 41 female) or control group which was 120 people (78 male, 42 female). Test group was received basic treatment plus 480mg of Zhibitai orally twice a day, whereas the control group was received basic treatment plus 10mg atorvastatin orally once daily (basic treatment means that conventional drug treatment: anti-platelet drug、nitrates agents、antihypertensive drugs and hypoglycemic agents in addition to lipid-lowering drugs). Blood lipoproteins, myocardial enzyme、liver and renal function were measured before treatment and at the fourth and eighth weeks after therapy , whereas hs-CRP、P-selectin、MMP-9、SIC AM-1 were detected before treatment and eighth week after therapy in all patients.
Results: TC、TG and LDL-C were significantly decreased but HDL was increased in both group individually after 4 and 8 weeks treatment(p<0.01). Inflammatory factors such as hs- CRP、P-selectin、MMP-9、SICAM-1 were decreased significantly. However there was no significant difference between the two groups. There were no difference in liver and kidney function, myocardial enzyme, incidence of muscle-ache and digestive system reaction.
Conclusion: Besides the lipoprotein disorder, the inflammatory factors in patients with moderate and high risk of atherosclerosis could be regulated by intensive therapy of Zhibitai. Most importantly, it is safe to use Zhibitai in clinic.
方法:选择我院2007年6月至2008年5月住院及门诊的冠心病中、高危患者240例,其中男性157例,女性83例,年龄在55-72岁;随机分为试验组120例(男79例,女41例)对照组120例(男78例,女42例)。试验组予以基本治疗十脂必泰胶囊480mg口服每日两次,对照组予基本治疗十阿托伐他汀10mg口服每日1次。(基本治疗:除降脂治疗以外,根据患者病情给予降压/降糖/其他治疗)。所有患者于治疗前及治疗后4周、8周分别检测血脂、心肌酶学、肝肾功能一次。所有患者于治疗前及治疗后8周分别检测hs-CRP、P-选择素、MMP-9、SICAM-1一次。
结果:两组治疗4周、8周后与治疗前比较TC、LDL-C显著下降(p＜0.05),HDL-C显著升高(p＜0.05);脂必泰组治疗4周、8周后与治疗前比较TG显著下降(P＜0.05),而阿托伐他汀组治疗4周与治疗前比较TG无显著下降(P＞0.05),治疗8周后TG显著下降(P＜0.05);两组治疗8周后hs-CRP、P-选择素、MMP-9、SICAM-1各炎症因子较治疗前均明显降低(p＜0.01),两组间比较差异无显著性(p＞0.05)。两组治疗前后肝肾功能、肌酶变化、肌病发生率,消化道反应发生率无统计学差异(p＞0.05)。
结论:强化脂必泰治疗除能有效调脂外,还能有效降低血脂异常的冠心病中、高危患者的炎症因子,且临床应用安全。
Objective: To evaluate the lipid lowing effects and the clinical safety of intensive therapy of Chinese medicine Zhibitai in patients with moderate and high risk of atherosclerosis.
Methods: 240 patients who were 55-72 year-old with moderate and high risk of atherosclerosis in our hospital from June 2007 to May 2008 were recruited. There were 157 male and 83 female among them. All the patients were randomly divided in to test group which was 120 people (79 male, 41 female) or control group which was 120 people (78 male, 42 female). Test group was received basic treatment plus 480mg of Zhibitai orally twice a day, whereas the control group was received basic treatment plus 10mg atorvastatin orally once daily (basic treatment means that conventional drug treatment: anti-platelet drug、nitrates agents、antihypertensive drugs and hypoglycemic agents in addition to lipid-lowering drugs). Blood lipoproteins, myocardial enzyme、liver and renal function were measured before treatment and at the fourth and eighth weeks after therapy , whereas hs-CRP、P-selectin、MMP-9、SIC AM-1 were detected before treatment and eighth week after therapy in all patients.
Results: TC、TG and LDL-C were significantly decreased but HDL was increased in both group individually after 4 and 8 weeks treatment(p<0.01). Inflammatory factors such as hs- CRP、P-selectin、MMP-9、SICAM-1 were decreased significantly. However there was no significant difference between the two groups. There were no difference in liver and kidney function, myocardial enzyme, incidence of muscle-ache and digestive system reaction.
Conclusion: Besides the lipoprotein disorder, the inflammatory factors in patients with moderate and high risk of atherosclerosis could be regulated by intensive therapy of Zhibitai. Most importantly, it is safe to use Zhibitai in clinic.
引文
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9、赵海,及元乔,天然降脂药物研究进展-脂必妥的研究,首都医药临床医学/药学,2002,9:70-71。
10、杨文姬,符晓洁,脂必妥和阿托伐他汀治疗高脂血症的疗效比较 中国现代医药科技论文 2003,2,2-4.
11、李八统,不同剂量脂必妥调脂疗效比较,现代中西医结合杂志2006,15(6):733,
12、阳军,李向平,不同剂量氟伐他汀早期干预对ACS炎症因子的影响 动脉粥样硬化基础与临床研究新进展 2004,3:99。
13、李盛姿,李平途,辛伐他汀与脂必妥治疗血脂异常的疗效比较 福建医药杂志 2006,28(2):139-140。
14、Libby P.Inflammation in atherosclerosis.Nature,2002,420:868-874.
15、李建军,炎症在动脉粥样硬化性疾病中的作用[J]中华心血管病杂志2008,36(3)193-194.
16、LiJJ,Wang HR,Huang CX.et al.Enbomced response ofbloud monocytes to C-realtive protein in patients with wnstable angina clin chim Acta,2005,352:127-133.
17、LiJJ.Li Gs,Fang CH.et al.Activation of nuclear factor-Rβand correlation with elevated plasma C-reactive protein:potential adjunct fur global risk assess-mentin the primary prevention of covrdiovascular disease.Circulation,2001;103:1813-1818.
18、LiJJ,Fang C-H,C-reactive protein is not only an inflom matory marder but also a direct cause of cardio-Vascular disease.Med.Hypotheses,2004;62:499-506.
19、Ridker PM,Rifai N,Lowenthal SP.Rapid reduction in C-reactive protein with Cerivastatin among 785 patients with primary hypercholesterolemia.Circulation,2001,103:1191-1193.
20、Peason TA,Mensah GA,Alexander RW,et al.Marder of inflommation and cardiovasular disease:application to clinical and public health practice:A statement for healthcare professionals from centers for Disease control and prevention and the American Heart Association.Circulation,2003:107(3).499-511.
21、姚魏,张秀兰,五风芝.血脂康对急性冠脉综合征的P-选择素,可溶性细胞间粘附因子-1,基质金属蛋白酶-9的影响,中华心血管病杂志,2006,34:1004.
22、梁晓萍,戴勇,石丹等MMP-9与冠心病相关性的临床研究[J]中国心血管病杂志 2002,7(2):54-57.
23、孙建平,刑广群,于宁等.高血压肾小球动脉硬化患者外周血单个核细胞中MMP-9及TGPβ1mRNA的表达[J]青岛大学医学院学报,2004,40(4):316-318。
24、Hobeika MJ,Thompson RW.Muhs BE,et al.Matrix metalloproteinases in peripheral vasular disease[J].J Vasc Surg,2007,45(4):849-857.
25、李江,赵水平等 急性心肌梗死早期普伐他汀治疗对血浆sCD40L金属蛋白酶-9及C-反应蛋白的影响 中华心血管病杂志,2003,31(3):165-168.
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2、Li JJ.Fang CH.Atheroscleritis is a more rational term for the pathological entity cunently knonn as atherosclerosis Med Hypotheses,2004,63:100-102.
3、Tracy RP.Inflammation in cardiovascular disease:care,horse.or both?circulation,1998,97:2000-202.
4、LiJJ Inflamonation:an imporeant mechomism for differ-ent dinical entities of coronary artery disease.Chin Med J,2005,118:1817-1826.
5、Ross R.The pathogenesis of atherosclerosis:a perspective for the 1990s.Nature.1993.363:801-809.
6、Sato T,Takebayashi S,Kohchi K.Increased subendothelial infiltration of the coronary arteries with monocytes/macrophages in patients with unstable angina.Atheroslerosis,1995,68:191-197.
7、Ridker PM,Rifai N,Lowenthal SP.Rapid reduction in C-reactive protein with cerivastatin among 785 patients with primary hypercholesterolemia Circulation,2001,103:1191-1193.
8、赵水平,他汀类药物非降脂作用研究现状,医学临床研究,2004,211-2。
9、赵海,及元乔,天然降脂药物研究进展-脂必妥的研究,首都医药临床医学/药学,2002,9:70-71。
10、杨文姬,符晓洁,脂必妥和阿托伐他汀治疗高脂血症的疗效比较 中国现代医药科技论文 2003,2,2-4.
11、李八统,不同剂量脂必妥调脂疗效比较,现代中西医结合杂志2006,15(6):733,
12、阳军,李向平,不同剂量氟伐他汀早期干预对ACS炎症因子的影响 动脉粥样硬化基础与临床研究新进展 2004,3:99。
13、李盛姿,李平途,辛伐他汀与脂必妥治疗血脂异常的疗效比较 福建医药杂志 2006,28(2):139-140。
14、Libby P.Inflammation in atherosclerosis.Nature,2002,420:868-874.
15、李建军,炎症在动脉粥样硬化性疾病中的作用[J]中华心血管病杂志2008,36(3)193-194.
16、LiJJ,Wang HR,Huang CX.et al.Enbomced response ofbloud monocytes to C-realtive protein in patients with wnstable angina clin chim Acta,2005,352:127-133.
17、LiJJ.Li Gs,Fang CH.et al.Activation of nuclear factor-Rβand correlation with elevated plasma C-reactive protein:potential adjunct fur global risk assess-mentin the primary prevention of covrdiovascular disease.Circulation,2001;103:1813-1818.
18、LiJJ,Fang C-H,C-reactive protein is not only an inflom matory marder but also a direct cause of cardio-Vascular disease.Med.Hypotheses,2004;62:499-506.
19、Ridker PM,Rifai N,Lowenthal SP.Rapid reduction in C-reactive protein with Cerivastatin among 785 patients with primary hypercholesterolemia.Circulation,2001,103:1191-1193.
20、Peason TA,Mensah GA,Alexander RW,et al.Marder of inflommation and cardiovasular disease:application to clinical and public health practice:A statement for healthcare professionals from centers for Disease control and prevention and the American Heart Association.Circulation,2003:107(3).499-511.
21、姚魏,张秀兰,五风芝.血脂康对急性冠脉综合征的P-选择素,可溶性细胞间粘附因子-1,基质金属蛋白酶-9的影响,中华心血管病杂志,2006,34:1004.
22、梁晓萍,戴勇,石丹等MMP-9与冠心病相关性的临床研究[J]中国心血管病杂志 2002,7(2):54-57.
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