不同剂量阿托伐他汀对急性冠脉综合征患者血浆可溶性OX40配体水平的影响

Effect of different dose of atorvastatin on plasma soluble OX40L level in patients with acute coronary syndrome

目的探讨不同剂量阿托伐他汀对急性冠脉综合征(ACS)炎症指标可溶性OX40配体(sOX40L)及高敏C反应蛋白(hs-CRP)的影响。方法收集47例因ACS住院的患者,随机分为小剂量组(阿托伐他汀10 mg/d)25例和大剂量组(阿托伐他汀20 mg/d)22例,治疗4周,测定治疗前后血浆sOX40L及hs-CRP的浓度。结果小剂量组和大剂量组的sOX40L及hs-CRP的血浆基线水平分别为:(27.69±10.52)ng/L和(28.24±10.01)ng/L,(11.69±7.09)mg/L和(11.91±6.36)mg/L,均显著高于以往报道的正常人群。治疗4周后,小剂量组和大剂量组sOX40L均显著下降,分别为(21.99±8.12)ng/L(t=10.732,P<0.01)和(17.51±4.84)ng/L(t=9.052,P<0.01),下降幅度分别为20.6%和38.0%,差异有统计学意义(t=2.252,P<0.05)。两组hs-CRP也显著下降,下降幅度分别为32.3%(t=5.496,P<0.01)和55.8%(t=8.006,P<0.01),两组间比较差异有统计学意义(t=2.702,P=0.01)。治疗前后sOX40L与hs-CRP均呈正相关性(R=0.765,P=0.00;R=0.742,P=0.00)。结论 ACS患者血浆sOX40L水平明显高于正常人群。他汀类药物治疗ACS患者可显著降低sOX40L,并且sOX40L降低与hs-CRP降低同步,呈剂量依赖性。sOX40L可能同hs-CRP一样,可作为他汀类药物抗炎作用的指标之一。

Objective To investigate the effect of different dose of atorvastatin on soluble OX40 ligand （sOX40L） and high-sensitivity C-reactive protein （hs-CRP） levels in patients with acute coronary syndrome （ACS）. Methods Forty-seven patients with ACS were randomly assigned into low dose group （atorvastatin 10 mg per day, n = 25 ） and high dose group （ atorvastatin 20 mg per day, n = 22 ）, and were followed up for 4 weeks. Plasma sOX40L and hs-CRP levels were analyzed at admission and 4 weeks after therapy. Results The baseline levels of sOX40L and hs-CRP in low dose group and high dose group were （27. 69 ± 10. 52） ng/L and （28.24 ± 10. 01 ） ng/L, （ 11.69±7.09） mg/L and （ 11.91 ±6. 36） mg/L respectively. After 4 weeks of treatment, sOXd0L levels were significantly decreased in both low dose group [（21.99±8.12） ng/L, t =10.732, P〈0.01] and high dose group [（17.51 ±4.84） ng/L, t =9.052, P〈0.01], with a reduction of 20. 6% and 38.0% respectively （t = 2. 252, P 〈 0. 05 ）. Significant drop were also observed in hs-CRP levels in both low dose group （ 32. 3%, P 〈 0. 01 ） and high dose group （ 55.8%, P 〈 0. 05 ）. Markedly positive correlations were found between sOX40L levels and hs-CRP levels before （R = 0. 765, P = 0. 00） and after therapy （R = 0. 742, P = 0. 00）. Conclusions Plasma sOX40L and hs-CRP levels were significantly increased in patients with ACS compared with healthy people. Atorvastatin significantly decreases sOX40L and hs-CRP levels in dose dependent fashion. Like hs-CRP, sOX40L may be another index for the evaluation of statin effect.