氟伐他汀早期干预对急性冠状动脉综合征患者血清炎症因子水平的影响

The effect of early fluvastatin therapy on inflammatory factors in acute coronary syndrome

目的探讨不同剂量氟伐他汀早期干预治疗对急性冠状动脉综合征(ACS)患者血清高敏C反应蛋白(hsCRP)、TNFα水平的影响。方法58例ACS患者随机分为A组常规治疗;B组为常规治疗加氟伐他汀40mg/d;C组为常规治疗加氟伐他汀80mg/d;稳定性冠心病患者为对照组。ACS患者在治疗1周前后分别测定血清hsCRP、TNFα及血脂水平。结果(1)ACS患者的血清hsCRP、TNFα水平明显高于稳定性冠心病患者(P<005)。(2)40mg/d和80mg/d氟伐他汀治疗1周后血清hsCRP及TNFα水平均有明显下降(P值均<001),而以80mg/d氟伐他汀组作用更明显。(3)Pearson相关分析显示ACS患者血清hsCRP与TNFα水平呈正相关(r=070,P<001),hsCRP和TNFα与血脂水平不相关。结论ACS患者血清炎症因子水平增高,早期氟伐他汀治疗可降低ACS患者的血清hsCRP和TNFα水平,且呈剂量依赖性。氟伐他汀的抗炎作用独立于降脂作用之外。早期他汀类药物强化治疗可能使ACS患者获益更大。

Objective To investigate the effects of different doses of fluvastatin on serum levels of high-sensitive C-reactive protein(hs-CRP) and tumour necrosis factor-α(TNFα) in the early phase of acute coronary syndrome(ACS). Methods Fifty eight patients with ACS were randomly separated into three groups. 20 patients in group A were given routine therapy, 20 patients in group B were given routine therapy with oral fluvastatin 40 mg once daily for 1 week and 18 patients in group C received routine therapy with oral fluvastatin 80 mg once daily for 1 week. 20 patients with stable coronary heart disease served controls. The serum levels of hs-CRP and TNFα before and after therapy were measured with immunoturbidimetric assay and ELISA method. Results (1)The serum levels of hs-CRP and TNFα in the patients with ACS were significantly higher than those in the control group(P<0.05). (2) The serum levels of hs-CRP and TNFα significantly lowered after one week of therapy in the two fluvastatin treated groups (P<0.01 in all),especially in the 80 mg fluvastatin group, while no significant difference was observed before and after treatment in the routine therapy group. (3)The serum levels of hs-CRP and TNFα had a significant positive correlation in the patients with ACS(r=0.70, P<0.01),but no relationship were observed between TC, TG, LDL-C, or HDL-C and hs-CRP or TNFα by Pearson correlation analysis. Conclusions The serum levels of inflammatory factors including CRP and TNFα are increased in patients with ACS and early fluvastatin intervention may decease dose-dependently the serum levels of hs-CRP and TNFα. The anti-inflammatory effect of fluvastatin may be beyond that of lipid lowering . Early intensive fluvastatin treatment may yield more significant benefits in the patients with ACS.