氟伐他汀缓释片对急性冠状动脉综合征合并糖尿病老年患者经皮冠状动脉介入治疗后的影响

Effects of fluvastatin retard tablets on the elder patients of acute coronary syndrome complicated with diabetes mellitus undergoing percutaneous coronary intervention

目的评价氟伐他汀缓释片对急性冠状动脉综合征（ACS）合并糖尿病老年患者经皮冠状动脉介入治疗（PCI）后的影响及药物安全性。方法选择2009年12月至2011年12月收治年龄≥65岁的ACS合并糖尿病行PCI患者78例，均应用药物洗脱支架行PCI，按随机数字表法分为A组（氟伐他汀缓释片80mg／d）和B组（氟伐他汀缓释片160mg／d），每组39例，术前、术后24h、术后7d检测血清高敏c反应蛋白（hs．CRP）、基质金属蛋白酶9（MMP．9）、单核细胞趋化蛋白1（MCP．1）和血脂水平。随访180d观察药物不良反应和心血管事件。结果两组术前、术后血脂水平无显著性变化。两组术后24h血清hs．CRP、MCP．1、MMP．9水平均高于术前[A组：（12．14±2．71）mg／L比（8．76±2．25）mg／L、（491．75±19．29）ng／L比,（440．56±13．15）ng／L、（449．6±11．8）μmol／L比（353．8±16．0）μmol／L；B组：（11．39±2．38）mg／L比（9．30±1．99）mg／L、（488．56±17．61）ng／L比（436．06±15．36）ng／L、（444．9±19．1）μmol／L比（349．8±13．6）μmol／L]，差异有统计学意义（P〈0．05）。两组术后7d及随访180d血清hs．CRP、MCP．1、MMP．9水平较术后24h下降，且B组比A组下降明显[术后7d：（4．51±1．16）mg／L比（5．43±1．44）mg／L、（306．06±18．49）ng／L比（384．64±13．23）ng／L、（206．2±16．8）μmol／L比（263．4±15．4）μmol／L；随访180d：（4．23±1．08）mg／L比（4．68±1．46）m#L、（280．16±14．54）ns／L比（354．64±11．32）．g／L、（187．2±14．2）灿moFL比（225．4±12．7）μmol／L]，差异有统计学意义（P〈0．05）。随访180d两组均未发生严重药物不良反应，B组总的心血管事件发生率低于A组[7．7％（3／39）比25．6％（10／39）]，差异有统计学意义（P〈0．05）。结论强化降脂更能降低ACS合并糖尿病老年患者PCI术后炎性因子水平，减少心血管事件，并具有很好的安全性。

Objective To assess the effects of fluvastatin retard tablets on the elder patients of acute coronary syndrome（ACS ） complicated with diabetes mellitus（DM ） undergoing percutaneous coronary in- tervention （PCI） and the safety of drugs. Methods From December 2009 to December 2011, 78 elderly patients （age ±〉 65 years） of ACS complicated with DM who underwent PCI were enrolled in this study. They were all treated by drug elution stents. They were divided into group A（fluvastatin retard tablets 80 mg/d） and group B （fluvastatin retard tablets 160 mg/d） with 39 cases each by random digits table method. The plasma levels of high sensitivity C reactive protein （hs-CRP）, matrix metalloproteinase proteinase 9 （MMP-9）, monocyte chemoattractant protein 1 （MCP-I） and lipid levels were measured before and after treatment of 24 h,7 d and 180 d. All the patients were followed up for 180 d, and the adverse reaction of drug and the incidence of cardiovascular event were detected. Results Blood lipid levels had no significant changes in the two groups before and after treatment （P 〉 0.05）. The plasma levels of hs-CRP, MCP-1, MMP-9 were higher after treatment of 24 h than those before treatment in two groups [group A： （ 12.14 ＋ 2.71 ）mg/L vs. （8.76 ±2.25） mg/L, （491.75 ±19.29） ng/L vs. （440.56 ±13.15） ng/L, （449.6 ±11.8） Ixmol/L vs. （353.8 ± 16.0） IX mol/L;group B： （11.39 ± 2.38 ） mg/L vs. （9.30 ± 1.99） mg/L, （488.56 ± 17.61 ） ng/L vs. （436.06 ± 15.36） ng/L, （444.9 ± 19.1 ） Ix mol/L vs. （349.8 ± 13.6）Ixmol/L], and there were significant differences （P 〈 0.05 ）. The plasma levels of hs -CRP, MCP-1, MMP-9 decreased significandy after treatment of 7,180 d compared with that after treatment of 24 h in two groups （P 〈 0.05）. Compared with those in group A, the plasma levels of hs-CRP, MCP-1, MMP-9 decreased even lower in group B[after 7 d： （4.51 ± 1.16） mg/L vs. （5.43 ＋ 1.44） mg/L, （306.06 ± 18.49） ng/L vs. （384.64 ± 13.23） ng/L, （206.2 ± 16.8） Ix mol/L vs. （263.4 ＋ 15.4） Ixmol/L;after 180 d： （4.23 ± 1.08） mg/L vs.（4.68 ± 1.46） rag/L, （280.16 ± 14.54 ） ng/L vs. （ 354.64 ± 11.32 ） ng/L, （ 187.2 ± 14.2 ） Ix mol/L vs. （ 225.4 ± 12.7 ） Ix mol/L ], and there were significant differences （P 〈 0.05 ）. After followed up for 180 d,there was no serious adverse reaction in two groups, and the total incidence of cardiovascular event in group B was lower than that in group A [7.7% （3/39） vs. 25.6%（10/39）],and there was significant difference （P 〈0.05）. Conclusion Intensive lipid lowering therapy can reduce the level of inflammatory factors and cardiovascular event of the elder patients of ACS complicated with DM undergoing PCI and has good security.