不同剂量辛伐他汀对急性冠状动脉综合征患者炎症因子的影响

Effects of different dose of simvastatin on plaque stability and eudothelial function in patients with acute coronary syndrome

目的观察不同剂量辛伐他汀对急性冠状动脉综合征(ACS)患者血清高敏C一反应蛋白(hs-CRP)、内皮素-1(ET-1)及血脂的影响,探讨不同剂量辛伐他汀在血管内皮功能、斑块稳定性和炎症反应中的作用。方法选取临床确诊为ACS患者80例,均总胆固醇(TC)≥4.68mmol/L和(或)低密度脂蛋白胆固醇(LDL-C)≥2.6mmol/L,年龄52岁～75岁。入院48h内空腹采静脉血测定血脂等生化指标及hsCRP、ET-1,将患者随机分为20mg组(A组,40例)和40mg组(B组,40例),均为每晚服药1次,分别于用药前,用药后4、12周测定TC、LDL-C、高密度脂蛋白胆固醇(HDL-C)、甘油三脂(TG)及hsCRP、ET-1,随访3个月内所有不良反应,观察终点为6个月后心脏事件的发生率。结果(1)两组服药后4、12周后TC、LDL-C、hsCRP、ET-1水平均较治疗前明显降低(P<0.05),B组较A组降低更明显,P<0.05;(2)B组累及心脏事件发生率较A组明显减少(P<0.05);(3)两组均无严重不良反应。结论ACS患者应用辛伐他汀40mg/d,能更有效地降脂,提高达标率,明显抑制炎症因子,改善内皮功能,稳定粥样斑块,减少住院率及心脏血管事件的发生率,且安全、耐受性好。

Objectives To explore the effects of different dose of simvastatin on plaque stability and inflammatory reaction （such as the changes of high sensitive-C reaction protein （hsCRP）, endothlin-1 （ET-1） and blood lipid） in patients with acute coronary syndrome. Method Eighty patients with ACS, age 52 to 75 years, the total cholesterol （TC） 〈4.68 mmol. L-1 and/or low-density lipoprotein（LDL） 〈2.6 mmol.L-1,were randomly divided into 2 groups： group A （n=40） gave simvastatin 20mg.d-1, group B （n=40） 40mg. d-1. The levels of blood triglycerides （TC）, LDL, high-density lipoprotein （HDL）, TG, and high sensititivity C-reactive protein（hsCRP）, endothlin-1 （ET-1） were all detected before and after 1 month, 3 months of the treament. All adverse reaction in 3 months were followed up. The primary ending point is the incidence of the cardiovascular disease. Restult After 1 month or 3 months of the treatment, the levels of blood TC, LDL, HDL, TG, hsCRP and ET-1 in the two groups were decreased significantly than those before the treatment, especially in group B（P 〈0.05 （. During the follow-up the incidence of cardiac events in group B was less than that in group A markedly, （ P 〈 0.05 （. No severe adverce effects were found in the two groups. Conclusion Early treatment with sinmvastatin 40 mg.d-1 had a good effect on the lowering of blood lipid , inhibiting the product of inflammatory factors , ameliorating endothelial function and reducing the incidence of cardiac events , while it is safe for the patients with ACS.