辛伐他汀对急性冠状动脉综合征炎症因子和内皮功能的影响

Effects of statins on pro-inflammatory factors and endothelial functions in acute coronary syndrome

目的探讨他汀类药物对急性冠状动脉综合征(ACS)患者炎症因子和内皮功能的影响,为ACS诊治提供依据。方法60例不稳定型心绞痛(UA)或非ST段抬高的急性心肌梗死(NSTEMI)住院患者在常规治疗(抗血小板聚集、β-受体阻滞剂、血管紧张素转换酶抑制剂、硝酸酯类等)基础上,随机分为加辛伐他汀组(40mg/d)和不加辛伐他汀组(对照组)。分别于治疗前,治疗后3、7d测量血清高敏感性C反应蛋白(hsCRP)、白细胞介素6(IL-6)、单核细胞趋化蛋白(MCP)-1、诱生型一氧化氮合酶(eNOS)水平。结果①hsCRP,IL-6,MCP-1,NOS基线水平:ACS患者外周血hsCRP,IL-6,MCP-1水平较正常参考值高,eNOS水平较正常参考值低,差异有统计学意义(P<0.05)。②治疗3、7d后hsCRP,IL-6,MCP-1水平:与对照组比较,辛伐他汀于治疗3、7dhsCRP分别降低15%和18%(P<0.05);MCP-1分别降低9%和14%(P<0.05);IL-6分别降低10%和16%,差异有统计学意义(P<0.05)。③eNOS:与对照组相比,治疗3、7d后,辛伐他汀上调eNOS水平6%和8%,但差异无统计学意义(P>0.05)。结论①在ACS患者炎症因子hsCRP,IL-6,MCP-1水平升高和eNOS水平降低,辛伐他汀治疗降低炎症因子水平并上调eNOS水平。

Objective As inflammation and endothelial function injury are shown to play a role in the process of acute coronary syndromes （ACS） and be associated with cardiovascular events, we evaluated the effects of statins on serum inflammatory factors and endothelial function markers （nitric oxide synthase） in ACS patients, to provide a rationale for management of this condition. Methods Sixty patients with unstable angina （UA） or non-ST segment elevation myocardial infaretion （NSTEMI） were divided into two groups, the control group （on conventional therapy） and Simvastatin group （40 mg/d added on conventional therapy）. Levels of serum high sensitivity C-reactive protein （CRP）, monocyte chemoattractant protein-1 （MCP-1）, interleukin-6 （IL-6）, and endothelial nitric oxide synthase （eNOS） were measured before treatment and at 3 and 7 days of therapy, respectively. Results 1. At baseline, serum levels of hsCRP, IL-6 and MCP-1 in these ACS patients were high and serum level of eNOS was lowered as compared with normal ranges, indicating significantly differences （P〈0.05）; 2. After 3 and 7 days of Simvastatin treatment, the serum level of hsCRP was reduced by 15% and 18% （both P〈0.05）, and MCP-1 were reduced by 9% and 14%, respectively （both P〈0.05）. IL-6 also showed a trend of reduction by 10% and 16%, respectively, there was statistical significance （P〈0.05）; 3. After 3 and 7 days of Simvastatin treatment, the serum level of eNOS increased by 6% and 8%, respectively, albeit statistically insignificant （P 〉0.05）. Conclusion The levels of hsCRP, IL-6,, MCP-1 were increased and eNOS decreased in acute coronary syndromes （ACS）. Treatment with Simvastatin may result in reduced levels of proinflammatory factors and improved endothelial function by up-regulation of nitric oxide synthase.