术前阿托伐他汀强化治疗在UA患者经皮冠状动脉介入治疗中的安全性分析
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摘要
目的分析术前阿托伐他汀强化治疗在不稳定型心绞痛(UA)患者经皮冠状动脉介入术(PCI)治疗中的安全性。方法选择本院2016年4至2018年4月收治的需进行PCI术治疗的UA患者120例为研究对象,按照随机数字表法将其分为研究组和对照组,各60例。研究组术前2 d予以80 mg阿托伐他汀片,术后40 mg/次,1次/d维持治疗,连续6个月;对照组术前2 d予以40 mg阿托伐他汀片,术后20 mg/次,1次/d维持治疗,连续6个月。比较两组治疗前、后肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)、高敏C反应蛋白(hs-CRP)、T细胞亚群(CD4~+、CD8~+、CD4~+/CD8~+)等各项指标的变化情况及不良反应发生情况。结果治疗后,两组患者的cTnI、CK-MB水平均升高,hs-CRP水平均降低,且研究组优于对照组,差异具有统计学意义(P<0.05)。治疗后,两组患者CD4~+水平、CD4~+/CD8~+均低于治疗前,CD8+水平均高于治疗前,且研究组明显优于对照组,差异具有统计学意义(P<0.05)。两组患者的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论 UA患者PCI术前进行阿托伐他汀的强化治疗效果显著,其可有效调节外周血T细胞亚群,改善动脉粥样硬化,降低机体炎症反应发生率,值得临床信赖并进一步推广应用。
Objective To analyze the safety of preoperative atorvastatin intensive therapy in patients with unstable angina(UA) undergoing percutaneous coronary intervention(PCI). Methods A total of 120 UA patients who needed PCI from 2014 to April 2018 were selected as study objects and divided into study group and control group according to random number table method, with 60 cases in each group. The study group was given 80 mg atorvastatin tablets at 2 days before operation and 40 mg per time and 1 time per day after operation for 6 months. The control group was given 40 mg atorvastatin tablets at 2 days before operation and 20 mg per time and 1 time per day after operation for 6 months. The changes of troponin I(cTnI), creatine kinase isoenzyme(CK-MB), high sensitivity C-reactive protein(hs-CRP), T cell subsets(CD4~+, CD8~+, CD4~+/CD8~+) before and after therapy and the incidence of adverse reactions were compared between the two groups. Results After treatment, the levels of cTnI and CK-MB in both groups increased while the levels of hs-CRP decreased, and those of the study group were better than the control group(P<0.05). After treatment, the levels of CD4~+ and CD4~+/CD8~+ in both groups were lower than those before treatment, and the levels of CD8~+ were higher than those before treatment, and those of the study group were significantly better than the control group, and the differences were statistically significant(P<0.05). There was no significant difference in the total incidence of adverse reactions between the two groups(P >0.05). Conclusion Intensive atorvastatin therapy before PCI applied in UA patients has a significant therapeutic effect, which can effectively regulate T lymphocyte subsets in peripheral blood, improve atherosclerosis and reduce the incidence of inflammation reactions. It is worthy of clinical trust and further promotion and application.
Objective To analyze the safety of preoperative atorvastatin intensive therapy in patients with unstable angina(UA) undergoing percutaneous coronary intervention(PCI). Methods A total of 120 UA patients who needed PCI from 2014 to April 2018 were selected as study objects and divided into study group and control group according to random number table method, with 60 cases in each group. The study group was given 80 mg atorvastatin tablets at 2 days before operation and 40 mg per time and 1 time per day after operation for 6 months. The control group was given 40 mg atorvastatin tablets at 2 days before operation and 20 mg per time and 1 time per day after operation for 6 months. The changes of troponin I(cTnI), creatine kinase isoenzyme(CK-MB), high sensitivity C-reactive protein(hs-CRP), T cell subsets(CD4~+, CD8~+, CD4~+/CD8~+) before and after therapy and the incidence of adverse reactions were compared between the two groups. Results After treatment, the levels of cTnI and CK-MB in both groups increased while the levels of hs-CRP decreased, and those of the study group were better than the control group(P<0.05). After treatment, the levels of CD4~+ and CD4~+/CD8~+ in both groups were lower than those before treatment, and the levels of CD8~+ were higher than those before treatment, and those of the study group were significantly better than the control group, and the differences were statistically significant(P<0.05). There was no significant difference in the total incidence of adverse reactions between the two groups(P >0.05). Conclusion Intensive atorvastatin therapy before PCI applied in UA patients has a significant therapeutic effect, which can effectively regulate T lymphocyte subsets in peripheral blood, improve atherosclerosis and reduce the incidence of inflammation reactions. It is worthy of clinical trust and further promotion and application.
引文
[1]徐燕,刘存义,宋雷.术前阿托伐他汀强化治疗对经皮冠状动脉介入术后外周血T细胞亚群的影响[J].安徽医药,2017,21(2):360-363.
[2]李帅,刘兵.负荷剂量阿托伐他汀对急性冠状动脉综合征患者经皮冠状动脉介入治疗围术期的影响[J].中国医院用药评价与分析,2017,17(4):472-473.
[3]唐群中,张学频,陈学智,等.丹参多酚酸盐联合阿托伐他汀对老年急性冠状动脉综合征患者经皮冠状动脉介入治疗术后血管内皮功能及炎性因子的影响[J].中国介入心脏病学杂志,2015,23(5):282-285.
[4]戚玮琳,范维琥.日本冠脉痉挛性心绞痛诊疗指南简介[J].国际心血管病杂志,2010,37(1):61-63.
[5] JANG Y,ZHU J,GE J,et al.Preloading with atorvastatin before percutaneous coronary intervention in statin-na ve Asian Patients with non-ST elevation acute coronary syndromes:a randomized study[J].J Cardiol,2014,63(5):335-343.
[6]谢文超,李平,王正东,等.不同剂量瑞舒伐他汀对不稳定性心绞痛患者支架置入术后心肌损伤的保护和抗炎作用[J].中国老年学杂志,2015,35(23):6727-6729.
[7]张淑琴,范恒,邓立军,等.阿托伐他汀钙联合阿司匹林对脑梗死患者血清Hcy、NSE、UA、hs-CRP及炎性因子水平的影响[J].海南医学院学报,2017,23(3):425-428.
[8]张旭,周麟,兰健.不同剂量阿托伐他汀对不稳定性心绞痛患者血清高敏C反应蛋白和胱抑素-C的影响[J].航空航天医学杂志,2016,27(3):308-309.
[9]刘新锋,关玲霞,杨昕远.阿托伐他汀强化治疗对急性心肌梗死合并糖尿病患者经皮冠状动脉介入术后心功能的影响[J].中国实用医刊,2015,42(6):47-49.
[10]杨丽香,李友文,张俊亭,等.不同剂量阿托伐他汀对糖尿病肾病应用利尿剂患者经皮冠状动脉介入术后对比剂肾病的预防作用观察[J].中国药物与临床,2015,15(11):1646-1648.
[11]刘桂华,刘亚平,王静,等.不同剂量阿托伐他汀钙对老年急性冠脉综合征患者经皮冠状动脉介入术疗效及炎症和凝血因子水平的影响[J].中国老年学,2016,36(19):4739-4741.
[12]王巍,金梅花.负荷剂量阿托伐他汀对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗心肌缺血-再灌注损伤的影响[J].齐齐哈尔医学院学报,2015,36(17):2500-2502.
[13] SUH JW,CHA MJ,LEE SP,et al.Relationship between statin type and responsiveness to clopidogrel in patients treated with percutaneous coronary intervention:a subgroup analysis of the CILON-T trial[J].J Atheroscler Thromb,2014,21(2):140-150.
[14]雷肖蠢,邱军杰.不同负荷剂量阿托伐他汀钙对高龄冠心病患者经皮冠状动脉介入术后预后影响的对比研究[J].实用心脑肺血管病杂志,2017,25(3):58-61.
[15]严凌,叶露,汪坤,等.阿托伐他汀可改善急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后无复流现象[J].浙江大学学报:医学版,2016,45(5):530-535.
[16] LIANG D,ZHANG Q,YANG H,et al.Anti-oxidative stress effect of loading-dose rosuvastatin prior to percutaneous coronary intervention in patients with acute coronary syndrome:a prospective randomized controlled clinical trial[J].Clin Drug Investig,2014,34(11):773-781.
[2]李帅,刘兵.负荷剂量阿托伐他汀对急性冠状动脉综合征患者经皮冠状动脉介入治疗围术期的影响[J].中国医院用药评价与分析,2017,17(4):472-473.
[3]唐群中,张学频,陈学智,等.丹参多酚酸盐联合阿托伐他汀对老年急性冠状动脉综合征患者经皮冠状动脉介入治疗术后血管内皮功能及炎性因子的影响[J].中国介入心脏病学杂志,2015,23(5):282-285.
[4]戚玮琳,范维琥.日本冠脉痉挛性心绞痛诊疗指南简介[J].国际心血管病杂志,2010,37(1):61-63.
[5] JANG Y,ZHU J,GE J,et al.Preloading with atorvastatin before percutaneous coronary intervention in statin-na ve Asian Patients with non-ST elevation acute coronary syndromes:a randomized study[J].J Cardiol,2014,63(5):335-343.
[6]谢文超,李平,王正东,等.不同剂量瑞舒伐他汀对不稳定性心绞痛患者支架置入术后心肌损伤的保护和抗炎作用[J].中国老年学杂志,2015,35(23):6727-6729.
[7]张淑琴,范恒,邓立军,等.阿托伐他汀钙联合阿司匹林对脑梗死患者血清Hcy、NSE、UA、hs-CRP及炎性因子水平的影响[J].海南医学院学报,2017,23(3):425-428.
[8]张旭,周麟,兰健.不同剂量阿托伐他汀对不稳定性心绞痛患者血清高敏C反应蛋白和胱抑素-C的影响[J].航空航天医学杂志,2016,27(3):308-309.
[9]刘新锋,关玲霞,杨昕远.阿托伐他汀强化治疗对急性心肌梗死合并糖尿病患者经皮冠状动脉介入术后心功能的影响[J].中国实用医刊,2015,42(6):47-49.
[10]杨丽香,李友文,张俊亭,等.不同剂量阿托伐他汀对糖尿病肾病应用利尿剂患者经皮冠状动脉介入术后对比剂肾病的预防作用观察[J].中国药物与临床,2015,15(11):1646-1648.
[11]刘桂华,刘亚平,王静,等.不同剂量阿托伐他汀钙对老年急性冠脉综合征患者经皮冠状动脉介入术疗效及炎症和凝血因子水平的影响[J].中国老年学,2016,36(19):4739-4741.
[12]王巍,金梅花.负荷剂量阿托伐他汀对急性ST段抬高型心肌梗死患者急诊经皮冠状动脉介入治疗心肌缺血-再灌注损伤的影响[J].齐齐哈尔医学院学报,2015,36(17):2500-2502.
[13] SUH JW,CHA MJ,LEE SP,et al.Relationship between statin type and responsiveness to clopidogrel in patients treated with percutaneous coronary intervention:a subgroup analysis of the CILON-T trial[J].J Atheroscler Thromb,2014,21(2):140-150.
[14]雷肖蠢,邱军杰.不同负荷剂量阿托伐他汀钙对高龄冠心病患者经皮冠状动脉介入术后预后影响的对比研究[J].实用心脑肺血管病杂志,2017,25(3):58-61.
[15]严凌,叶露,汪坤,等.阿托伐他汀可改善急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后无复流现象[J].浙江大学学报:医学版,2016,45(5):530-535.
[16] LIANG D,ZHANG Q,YANG H,et al.Anti-oxidative stress effect of loading-dose rosuvastatin prior to percutaneous coronary intervention in patients with acute coronary syndrome:a prospective randomized controlled clinical trial[J].Clin Drug Investig,2014,34(11):773-781.