辛伐他汀对PCI术后血浆可溶性Fas因子的影响

Effect of Simvastatin on Plasma Soluble Fas after Percutaneous Coronary Intervention

目的探讨老年冠心病患者经皮冠状动脉介入治疗术前后血浆可溶性Fas因子的改变以及与再狭窄的关系,并通过给予辛伐他汀干预治疗,观察其对血浆可溶性Fas因子的影响。方法选择行经皮冠状动脉介入治疗术的老年患者35例(老年PCI组),再根据6个月后回访冠状动脉造影结果又分为再狭窄组(21例)和无再狭窄组(14例);选择同期行皮冠状动脉介入治疗的非老年患者35例(非老年PCI组,冠心病组)和同期冠状动脉造影正常者35例为正常对照组;另选择同期行PCI治疗40例老年患者作短期辛伐他汀干预观察,干预组和对照组各20例,采用酶联免疫吸附测定血浆可溶性Fas因子水平。结果:经皮冠状动脉介入治疗术后再狭窄组血浆可溶性Fas(513±135ng·L-1)显著高于正常对照组,(51±14ng·L-1)、非老年PCI组(146±28ng·L-1)和无再狭窄组(142±30ng·L-1)(P均<0.01);非老年PCI组和无再狭窄组血浆可溶性Fas也高于正常对照组(P均<0.01);而非老年PCI组和无再狭窄组之间血浆可溶性Fas差异无显著性。择期冠状动脉介入治疗术后6h血浆可溶性Fas水平急剧增高;术后3d对照组血浆可溶性Fas升高达最高峰,辛伐他汀治疗组则显著降低(分别为1987±413和1124±253ng·L-1,P<0.01);术后7d对照组仍维持在高水平,治疗组下降至最低水平(分别为1325±237和598±104ng·L-1,P<0.01)。结论冠心病患者血浆可溶性Fas因子水平明显增高,并在行经皮冠状动脉介入治疗后进一步增高,且以老年人显著;再狭窄患者血浆可溶性Fas因子水平明显高于无再狭窄患者,辛伐他汀干预可显著降低血浆可溶性Fas因子水平,提示对接受经皮冠状动脉介入治疗的老年患者更应强调调脂、抗炎及稳定斑块的治疗。

Objective To analyze the changes of plasma soluble Fas in old patients with coronary heart disease （CHD） after percutaneous coronary intervention and relationship with the restenosis. Methods Consecutive patients with coronary heart disease receiving PCI were divided into adult group （〈60 years, n=35）, aged group （≥60 years, n=35）. According the coronary angiographic results in the 6th months follow-up, aged PCI patients were divided into restenosis and non-restenosis group, 35cases with normal coronary angiographicy as normal control group, and 40 patients treated with selective PCI were divided into simvastatin treating group （20 cases） and control group （20 cases）. The levels of plasma soluble Fas were examined by means of enzyme-linked immunsorbent assay. Results The levels of soluble Fas in patients with restenosis 6 months after percutaneous coronary intervention were significantly higher than those patients without restenosis, those patients with coronary heart disease and those patients without stenosis in coronary angiography （513±135 vs 146±28, 142±30, 51±14 ng.L^-1, respectively, P〈0.01）. The levels of soluble Fas were also significantly higher in patients without restenosis after percutaneous coronary intervention and in patients with coronary, heart disease than those patients without stenosis in coronary angiography （P〈0.01）. The levels of soluble Fas were rapidly increased in patients 6h after selective percutaneous coronary intervention, reached its peak after 3d, and remained very high aider 7d. The levels of soluble Fas were significantly decreased in patients 3d and 7d after treatment with simvastatin than those patients without simvastatin （from 1987±413 to 1325±237ng·L^-1, and 1124±253 to 598±104ng·L^-1, respectively, P〈0.01）. Conclusions The levels of soluble Fas were significantly higher in patients with CHD and rapid increased after PCI, especially in aged CHD patients with restenosis. Persist increment of soluble Fas may act as the predictors of restenosis after PCI. The levels of Fas significantly decreased after treatment of simvastatin.