不同调脂方案对冠心病患者ICAM-1、VCAM-1和MCP-1的影响

Effects of different applications of statins on ICAM-1,VCAM-1 and MCP-1 in patients with coronary heart diseases

目的探讨不同调脂方案对冠心病患者细胞间黏附分子-1(ICAM-1)、血管细胞黏附分子-1(VCAM-1)和单核细胞趋化蛋白-1(MCP-1)的影响。方法选取冠状动脉狭窄50%～70%的冠心病患者42例,均不植入支架,分为单用他汀组(n=19)和联合治疗组(n=23)。单用他汀组患者第1～4周服用阿托伐他汀20 mg,第5～12周服用阿托伐他汀40 mg;联合治疗组第1～4周服用阿托伐他汀5 mg+依折麦布10 mg,第5～12周服用阿托伐他汀10 mg+依折麦布10 mg。分别在治疗前、治疗后第4周和12周抽取患者静脉血,测定血脂、肝肾功能、肌酸激酶以及ICAM-1、VCAM-1、MCP-1浓度。结果①单用他汀组和联合治疗组患者治疗后第4周TC和LDL-C浓度均明显下降,第12周时分别较治疗前下降37.82%和38.26%,与治疗前比较差异均有统计学意义(P<0.01);但组间比较差异无统计学意义(P>0.05)。②两组患者肝肾功能和磷酸肌酸激酶在治疗后均无明显升高。③单用他汀组在治疗后第12周时ICAM-1、VCAM-1和MCP-1水平明显降低,与治疗前比较差异有统计学意义(P<0.05);与联合治疗组比较差异也有统计学意义(P<0.05)。结论单用较大剂量他汀对冠状动脉狭窄50%～70%的冠心病患者的斑块稳定性作用可能优于小剂量他汀和依折麦布的联合治疗。

Objective To investigate the effects of different applications of statins on intercellular adhesion molecule-1(ICAM-1),vascular cell adhesion molecule-1(VCAM-1) and monocyte chemoattractant protein-1(MCP-1) in patients with coronary heart diseases. Methods Forty-two patients with coronary heart disease(coronary artery stenosis between 50% and 70%) without stent implantation were divided into monotherapy group(n=19) and combined therapy group(n=23).Patients in monotherapy group were treated with 20 mg atorvastatin from the first week to the fourth week,and were managed with 50 mg atorvastatin from the fifth week to the twelfth week.Patients in combined therapy group were treated with 5 mg atorvastatin+10 mg ezetimibe from the first week to the fourth week,and were managed with 10 mg atorvastatin+10 mg ezetimibe from the fifth week to the twelfth week.Blood samples were collected before treatment and 4 weeks and 12 weeks after treatment,and blood lipid,liver and renal function and concentrations of creatine kinase,ICAM-1,VCAM-1 and MCP-1 were measured. Results The concentrations of TC and LDL-C in monotherapy group and combined therapy group significantly decreased 4 weeks after treatment,and the concentrations of TC and LDL-C 12 weeks after treatment were significantly lower than those before treatment(decreased by 37.82% and 38.26%,respectively)(P<0.01).However,there was no significant difference between these two groups(P>0.05).There was no significant increase in liver and renal function and concentration of creatine kinase after treatment in these two groups.Twelve weeks after treatment,the concentrations of ICAM-1,VCAM-1 and MCP-1 in monotherapy group were significantly lower than those before treatment,and there were significant differences between monotherapy group and combined therapy group(P<0.05). ConclusionMonotherapy with larger dose of statins may be superior to combined therapy with smaller dose of statins and ezetimibe in plaque stabilization in patients with coronary heart diseases.