不同剂量缬沙坦应用于冠状动脉介入术后患者血清单核细胞趋化蛋白-1和单核细胞受体γ的变化

Effect of different doses of valsartan on serum monocyte chemotactic protein - 1, and peripheral peroxisome proliferator activated receptor T level in coronary heart disease patients after coronary intervention

目的探讨不同剂量缬沙坦应用于冠状动脉介入（PCI）术后患者血清单核细胞趋化蛋白-1（MCP-1）和单核细胞过氧化物酶体增殖激活物受体γ（PPARγ）的变化及预防支架内再狭窄的效果。方法行PCI的急性冠脉综合征（ACS）患者200例，随机分为高剂量组和低剂量组，每组各100例，分别给予其缬沙坦160mg和40mgI：1服；于行PCI术前、术后1d、术后1周复查冠状动脉造影时，酶联免疫吸附试验（ELISA）法测定血清PPA脚和MCP-1水平。平均随访半年，复查时行冠脉造影。结果（1）和术前比较，术后1d低剂量组和高剂量组患者血清PPARγ[（158．77±74．63）、（266．55±77．46）ng／L]、MCP-1[（818．24±60．33）、（820．68±64．87）μg／L]及MCP-1／PPARγ比值（3．44±0．94、3．02±0．48）均明显升高（P〈0．05）；和术后第1天比较，术后1周低剂量组和高剂量组患者血清PPA脚[（494．75±55．58）、（597．89±67．75）ng／L]均显著上升，MCP．1[（652．47±52．62）、（320．76±42．22）μg／L]及MCP-1／PPARγ比值（1．22±0．28、0．56±0．16）均显著下降（P〈0．05）；复查时，低剂量组和高剂量组患者血清PPARγ[（517．68±47．92）、（736．05±70．12）ng／L]均明显高于术前，MCP-1[1（144．68±57．27）、（46．63±32．53）μg／L]及MCP-1／PPARγ（0．68±0．11、0．08±0．10）比值均明显低于术前（P〈0．05）。（2）术后l周及复查时高剂量组患者血清PPA脚明显高于低剂量组，MCP-1及MCP-1／PPARγ明显低于低剂量组，差异有统计学意义（P〈0．05）。（3）复查冠脉造影时高剂量组共有4例（4．5％）患者出现支架内再狭窄，低剂量组有18例（19．8％），差异有统计学意义（P〈0．05）。结论大剂量缬沙坦应用于患ACS行PCI患者可以促进其血清PPAR-γ水平上升及MCP-1血清水平、MCP-1／PVAR-γ比值下降，对预防PCI术后支架再狭窄，降低不良心血管事件发生率疗效显著。

Objective To study the effect of valsartan applied to coronary intervention （PCI） patients on serum monocyte chemoattractant protein - 1 （ MCP - 1 ） and monocyte peroxisome proliferator - activated receptor γ（PPARγ） and preventive effects of stent restenosis. Methods 200 patients with acute coronary syndrome （ACS） undergoing PCI were randomly divided into high- dose valsartan （160 mg） group and low-dose valsartan （40 mg） group （n = I00 each）. Before and one day and one week after PCI, and on the time of coronary angiography recheck, serum PPARγ and MCP - 1 levels were measured by enzyme linked immunosorbent assay （ELISA）. The average follow - up period was 6 months. Results （ 1 ） Compared with before PCI, serum PPARγ [ （ 158. 77 ± 74. 63 ）, and （266. 55 ± 77.46 ） ng/L ], MCP - 1 [ （818.24 ±60. 33）, and （820. 68 ±64. 87） μg/L] and MCP - 1/PPAR,/ratio （3.44 ±0. 94, and 3.02 ± 0. 48） in low - dose group and high - dose group one day after PCI were significantly increased （P 〈0. 05）. As compared with postoperative day 1, serum PPARγ [ （494. 75±55.58）, and （597. 89 ±67. 75） ng/L] were significantly increased, MCP - 1 [ （652. 47±52. 62）, and （320. 76 ±42. 22 ） μg/L ] and MCP - 1/PPARγ ratio （ 1.22 ± 0. 28, and 0. 56 ±0. 16） were significantly decreased in low - dose group and high - dose group one week after PCI （P 〈 0. 05 ）. On the recheck, serum PPAR＇y [ （517.68 ±47.92）, and （736. 05± 70. 12） ng/L] was significantly higher, MCP - 1 [ （ 144. 68± 57.27 ）, and （46. 63±32. 53） μg/L] and MCP - 1/PPARγ ratio （0. 68 ±0. 11, and 0. 08±0. 10） were significantly lower than before PCI in both low- dose group and high- dose group （P 〈 0. 05 ）. （2） On the first week and recheck after PC1, serum PPARγ was significantly higher, and MCP - 1 and MCP - I/PPAR3, were significantly lower in high - dose group than in low - dose group （ P 〈 0. 05 ）. （ 3 ） At the recheck of coro- nary angiography, in - stent restenosis occurred in 4 cases （4. 5% ） of high - dose group, and 8 （19. 8% ） in low - dose group （ P 〈 0. 05 ）. Conclusion High dose of valsartan applied to the ACS patients undergo- ing PCI can contribute to increased serum levels of PPARγ, and decreased serum levels of MCP - 1 and MCP-1/PPARγratio, which can effectively prevent the restenosis after PCI, and reduce adverse cardio- vascular events.