不同剂量阿托伐他汀对老年急性冠脉综合征患者血清网膜素1的影响

急性冠状动脉综合征(acute coronary syndrome ,ACS )的发生与冠心病息息相关,动脉粥样硬化是其病理基础[1]。

ACS 的治疗目前主要有经皮冠状动脉介入、心脏搭桥手术及药物保守治疗。

ACS 的二级预防药物以他汀类为主,这类药物的应用能够通过降低患者低密度脂蛋白胆固醇表达减少其冠状动脉粥样斑块形成。

此外,还具有抗炎、稳定斑块、防止血栓形成、改善血管内皮功能等作用,这类作用机制均对ACS 患者有益[2]。

但值得注意的是,ACS患者多为老年人群,因受其本身的特殊性及对药物[摘要]目的对比分析不同剂量阿托伐他汀治疗老年急性冠状动脉综合征(ACS )的价值,观察药物对患者血清网膜素-1的影响,为未来ACS 的治疗提供参考。

方法前瞻性选择丰台医院2017年3月~2018年5月诊治的ACS 老年患者120例,根据随机数表法分为3组,即低剂量组、常规剂量组、高剂量组各40例。

全部患者均接受ACS 常规治疗,并在此基础上分别给予低剂量组阿托伐他汀10mg/d ,常规剂量组20mg/d ,高剂量组40mg/d ,连续治疗4周。

治疗期间,记录各组不良反应发生情况,分别于治疗前、治疗结束时,检测并对比3组血脂总胆固醇(TC )、三酰甘油(TG )、高密度脂蛋白胆固醇(HDL-C )、低密度脂蛋白胆固醇(LDL-C )、炎症因子白细胞介素-6(IL-6)、超敏C 反应蛋白(hs-CRP )及血清网膜素-1水平变化情况。

结果3组治疗期间均有不良反应发生,其中高剂量组略高于其他两组,但组间比较差异无统计学意义(P >0.05)。

治疗结束时,高剂量组TC 、LDL-C 、IL-6、hs-CRP 表达最低,HDL-C 表达最高,其次为常规剂量组、低剂量组,组间比较差异有统计学意义(P <0.05);3组间TG 表达比较,差异无统计学意义(P >0.05)。

结论各剂量阿托伐他汀治疗老年ACS 均有一定效果,其中高剂量(40mg/d )用药获得效果最佳,患者血脂水平改善,炎症反应减轻,血清网膜素-1表达增加,且用药不良反应未见大幅度增加,但药物的应用可能会增加患者肝功能异常风险,实际应用中还应根据患者个体情况决定药用剂量,并在治疗期间严密监测其肝功能,必要时减量或停止用药。

[关键词]急性冠脉综合征;老年患者;阿托伐他汀;血清网膜素-1[中图分类号]R543.3[文献标识码]A DOI :10.3969/.issn.1674-3245.2019.02.013·论著·不同剂量阿托伐他汀对老年急性冠脉综合征患者血清网膜素-1的影响于凝,惠永明,马超,仲崇星Effect of different doses of atorvastatin on serum omentin-1in senile patients with acute coronary syndromeYu Ning ,Hui Yongming ,Ma Chao ,et al(Department of Cardiology ,Beijing Fengtai Hospital ,Beijing ,100070)[Abstract ]Objective To compare the value of different doses of atorvastatin in treatment of senile patients with acute coronary syndrome (ACS ),to observe its effect on serum omentin-1,and to provide reference for treatment of ACS.Methods 120senile ACS patients diagnosed in the hospital from March 2017to May 2018were selected.All the cases were divided into three groups by random number table ,low -dose group ,routine -dose group and high -dose group ,with 40cases in each group.All the patients received routine ACS treatment.On this basis ,low-dose group was given 10mg/d atorvastatin ,routine-dose group was given 20mg/d atorvastatin ,and high-dose group was given 40mg/d atorvastatin ,with 4weeks of treatment.The adverse reactions of three groups during treatment were recorded.Before treatment and at the end of treatment ,the blood lipid [total cholesterol (TC ),triglyceride (TG ),high density lipoprotein cholesterol (HDL-C ),low density lipoprotein cholesterol (LDL-C )],inflammatory factors [interleukin-6(IL-6),high-sensitivity C-reactive protein (hs-CRP )]and serum omentin-1in the three groups were detected and compared.Results There were adverse reactions in the three groups during treatment ,the high-dose group was slightly than other two groups ,and there was no statistical difference among groups (P >0.05);At the end of treatment ,the expression of TC and LDL-C in high-dose group was the lowest ,the expression of HDL-C in high-dose group was the highest ,followed by routine-dose group and low-dose group (P <0.05);There was no statistical difference in the expression of TG among the three groups (P >0.05);At the end of treatment ,the expression of IL-6and hs-CRP in high-dose group was the lowest ,the expression of serum omentin-1in high-dose group was the highest ,followed by routine-dose group ,and the low-dose group was the lowest (P <0.05).Conclusion The different doses of atorvastatin in treatment of senile ACS have certain effects ,and the effects of high-dose (40mg/d )medication are the best.It can improve blood lipid levels ,reduce inflammatory response ,increase the expression of serum omentin -1,and not significantly increase adverse reactions.However ,the application of the drug may increase the risk of liver dysfunction in the patients.In practice ,the dosage should be determined according to the patients'specific conditions ,and the liver function should be closely monitored during the treatment period ,and the drug should be reduced or stopped if necessary.[Key words ]Acute coronary syndrome ;Senile patients ;Atorvastatin ;Different doses ;Serum omentin-1作者单位:100070北京,丰台医院心内科应用剂量耐受性等因素的影响,在给予其他汀类药物治疗时,该选择何种剂量既保证疗效又保证安全一直备受临床关注[3]。

目前,临床多关注他汀类药物的降脂之效,在其他作用机理方面研究并不多见。

网膜素-1参与机体能量代谢平衡、心血管调节,并抑制炎症反应,并在冠心病发生发展中起保护之效,具有抗氧化、抗炎、抗动脉粥样硬化等功能[4-5]。

为进一步证实阿托伐他汀治疗老年ACS的价值,并找到更为安全有效的药物应用剂量,本研究对老年ACS患者分别给予不同剂量的阿托伐他汀治疗,旨在对比不同剂量阿托伐他汀用于老年ACS治疗的价值,分析患者血清网膜素-1所受影响,为未来老年ACS的治疗提供参考。

1对象与方法1.1对象选取北京丰台医院2017年3月~ 2018年5月诊治的ACS老年患者120例,其中男性67例,女性53例;年龄61~80岁,平均(71.45±4.57)岁。

全部患者在入院后均由有经验的医生评估,均接受冠状动脉造影,包括66例单支病变,41例双支病变,13例多支病变;行介入治疗111例, CABG5例,药物保守治疗4例;ST段抬高型心肌梗死(st-elevation myocardial infarction,STEMI)21例,非ST段抬高型心肌梗死(non st-elevation myocardial infarction,NSTEMI)33例,不稳定型心绞痛(unstable angina pectoris,UA)66例;合并高血压者41例,合并糖尿病者21例。