负荷量加高维持量阿托伐他汀对ACS患者介入治疗后血管内皮功能、血小板活化及炎性因子的影响

Influence of atorvastatinon at load dosage and high maintenance dosage on vascular endothelial function,platelet activation and inflammatory factor of patients with acute coronary syndrome after interventional therapy

目的:探讨负荷量加高维持量阿托伐他汀对急性冠脉综合征(ACS)患者介入治疗后血管内皮功能、血小板活化及炎性因子的影响。方法:选取急性冠脉综合征患者120例,按照就诊顺序将其随机分为常规剂量组和负荷剂量组两组,各60例。两组均进行常规药物治疗和经皮冠状动脉介入治疗(PCI),另外常规剂量组给予阿托伐他汀20mg/d,负荷剂量组于术前给予阿托伐他汀80mg,术后给予40mg/d维持剂量,持续治疗4周后调整为20mg/d维持治疗,比较两组治疗前后血管内皮功能、血小板活化及炎性因子水平的变化。结果:两组患者PCI术后血浆内皮素-1(ET-1)、P选择素(CD62P)和糖蛋白(GP)Ⅱb/Ⅲa水平有所升高,一氧化氮(NO)水平有所降低,但两组间比较无显著性差异(P>0.05);负荷剂量组术后4周ET-1、CD62P和GPⅡb/Ⅲa水平显著降低,NO水平显著升高,与PCI术前和常规剂量组比较差异均具有统计学意义(P<0.05);两组患者PCI术后各项炎性因子水平较治疗前均明显升高(P<0.05),但两组间比较差异无统计学意义(P>0.05);负荷剂量组PCI术后4周IL-6、TNF-α和hs-CR水平显著降低,且与对照组比较差异均具有统计学意义(P<0.05)。结论:负荷量加高维持量阿托伐他汀可以有效改善急性冠脉综合征患者PCI术后血管内皮功能,抑制血小板活化和炎症反应,具有较好的临床效果,值得大力推广和应用。

Objective： To investigate the influence of atorvastatinon at load dosage and high maintenance dosage on on vascular endothelial function, platelet activation and inflammatory factor of patients with acute coronary syndrome after inter- ventional therapy. Methods： A total of 120 cases of with acute coronary syndrome were randomly divided into the conventional dose group and the load dosage group according to the order of treatment by half. Two groups both were given with routine drug therapy and pereutaneous coronary intervention （PCI）, in addition the conventional dose groupwere given atorvastatin 20mg/d, load dosage group were given atorvastatin 80 mg in the before surgery, 40 mg/d maintenance dose after surgery. Treat- ment course was 4 weeks. Changes of platelet activation andendothelial function, inflammatory factor levels were compared be- fore and after treatment in two groups. Results.. After PCI, ET-1 ,CD62P and GP Ⅱ b/Ⅲ A levels of the two groups were in- creased, NO level were decreased, but the two groups showed no significant difference （P〉0.05）. After operation 4 weeks, ET-1, CD62P and GP Ⅱb/Ⅲ a levels of loading dose group were significantly decreased, NO levels were significantly increased, compared with the preoperative PCI and Conventional dose group the differences were statistically significant （P~ 0.05） ,the level of inflammatory factors of the two groups after PCI treatment were significantly increased than that before （P 〈0.05）, but no significant difference between the two groups （P〉0.05）. IL-6, TNF- alpha and hs-CR levels of loading close group after the PCI operation 4 weeks, were significantly decreased, and the difference compared with the control group were statistically significant （P〈0.05）. Conclusion： Atorvastatinon at load dosage and high maintenance dosage on can effectively improve the acute coronary syndrome of vascular endothelial function in patients with postoperative PCI, inhibit platelet activation and inflammatory reaction. It has good clinical effect, and is worthy of popularizing and application.