强化降脂治疗对急性冠脉综合征合并糖尿病老年患者炎症因子和预后的影响

Effects of intensive lipid lowering therapy on inflammatory factors and prognosis in the elder patients with acute coronary syndrome complicated with diabetes mellitus

目的探讨早期强化降脂治疗对急性冠脉综合征(ACS)合并糖尿病老年患者炎症因子和预后的影响及强化降脂的安全性。方法选择82例老年ACS合并糖尿病患者,随机分为常规他汀治疗组和强化他汀治疗组各41例,分别使用A组20mg和B组40mg阿托伐他汀进行治疗。检测7天时高敏C反应蛋白(hs-CRP)、单核细胞趋化蛋白-1(MCP-1)、纤维蛋白原(Fib)、基质金属蛋白酶9(MMP-9)和血脂水平。随访两组1年心血管事件和不良反应。结果两组治疗前、治疗后血脂水平无显著性变化;A组hs-CRP、MCP-1、MMP-9水平有显著性下降,B组4种炎症因子均有显著性下降,且比A组下降明显;1年后B组总的心血管事件发生率较A组低,两组均未发生严重不良反应。结论老年急性冠状动脉综合征合并糖尿病患者强化降脂治疗能够降低炎症因子水平,减少心血管事件,且具有很好的疗效和安全性。

Objective To observe the effects of intensive lipid lowering on inflammatory factors and prognosis in the elder patients with acute coronaey syndrome complicated with diabetes mellitus （ACS）. Method Total 82 patients with ACS were randomly divided into two groups： group A contained 41 patients administered with 20 mg/＇d atorvastatin besides of routine treatment ,group B contained 41 patients administered with 40 mg/d atorvastatin besides of routine treatment. Before and after the treatment for one week, the plasma levels of inflammatory factors （hs-CRP, MCP-1, MMP-9, Fib） and blood lipid （TC ,TG, LDL-C, HDL-C） were detected. Result Blood lipid levels had no significant change in the two groups after treatment for one week. The inflammatory factors of hs-CRP ,MCP-1 ,Fib and MMP-9 decreased singnificantly in group A and group B after treatment with atorvastain for one week, and the changes were more significant in group B than that in group A. The incidence of cardivascular disease in group B was less than that in group A after treatment with atorvastain for one year. No severe adverse effects were found in two groups. Conclusion Intensive lipid lowering therapy could reduce the levels of inflammatory factors, stable atherosclerotic plaque, reduce the incidence of cardiovascular disease and significantly improve prognosis of patiente with ACS. Intensive stain therapy has good effects and safety for patients with ACS complicated with diabetes mellitus.