早期阿托伐他汀联合普罗布考治疗对急性冠状动脉综合征患者血管内皮功能的影响

Effects of atorvastatin, alone and in combination with probucol on endothelial function in patients with acute coronary syndrome

目的观察阿托伐他汀联合普罗布考早期治疗对急性冠状动脉综合征（ACS）患者血管内皮功能的影响。方法30例ACS患者在入院24h内随机分到他汀组（阿托伐他汀20mg／d，n=15）与联合治疗组（阿托伐他汀20mg／d和普罗布考500mg／d，n=15）。治疗前、治疗1周和4周后分别检测患者血清血脂与高敏C反应蛋白（hs—CRP）水平，并应用高频超声测肱动脉血流介导的内皮依赖血管舒张功能（FMD）和由硝酸甘油诱导的内皮非依赖血管舒张功能（NMD）。结果经治疗1和4周后，两组血清总胆固醇、低密度脂蛋白胆固醇（LDL—C）和hs—CRP水平均低于治疗前，联合治疗组血清总胆固醇水平下降较他汀组更明显（P〈0．05）。治疗1周后，FMD均明显高于治疗前（他汀组：3．75％±0．78％比1．09％±0．44％；联合治疗组：3．67％±0．36％比1．24％±0．37％；均P〈0．01），两组比较差异无统计学意义。联合治疗组4周后FMD明显高于1周后（6．85％±0．64％比3．67％±0．36％，P〈0．01）；他汀组则无显著变化（P=0．954）。两组NMD在治疗4周后均明显高于治疗前（P〈0．01），但两组比较差异无统计学意义。相关分析显示，FMD和NMD的改善与血脂或hs—CRP水平的变化无显著相关。结论提示早期阿托伐他汀联合普罗布考治疗较单用阿托伐他汀能更明显地改善ACS患者的血管内皮功能。

Objectives To evaluate the effects of combined atorvastatin and probucol use on endothelial function in patients with acute coronary syndrome （ACS）. Methods Thirty patients with ACS were randomized to receive atorvastatin （20 mg/d） and probucol （500 mg/d, combination group, n = 15） or atorvastatin （20 mg/d） alone （ atorvastatin group） within 24 h after admission for 4 weeks. Endothelium-dependent flow-mediated dilatation （FMD） and endothelium-independent sublingual nitroglycerin-mediated dilatation （NMD） as well as the levels of lipids and C-reactive protein were assessed at baseline, 1 week and 4 weeks after therapy. Results Compared to baseline, the levels of total cholesterol, LDL-C and C-reactive protein were significantly reduced after 1 week and 4 weeks in both groups, FMD equally increased after 1 week in both groups （atorvastatin group： 3.75% ± 0.78% vs. 1.09% ±0.44%, combination group： 3.67% ±0. 36% vs. 1.24% ±0. 37% , P 〈0. 01）. Post 4 weeks therapy, FMD increase was significantly higher in combination group （3.67% ±0. 36% at 1 week vs. 6. 85% ±0. 64% at4 weeks, P 〈0. 01） than that in atorvastatin group （3.75% ±0. 78% vs. 3.80% ±0. 31%, P = 0. 954）. NMD also equally and increased over 4 weeks in two groups （P 〈 0. 01 vs. baseline）. There was no correlation between the change in FMD/NMD and the changes in lipids or C-reactive protein levels. Conclusions The combined atorvastatin and probucol therapy early after ACS is superior to atorvastatin alone on improving endothelial function.