瑞舒伐他汀对急性冠脉综合征患者经皮冠状动脉介入术后血管内皮功能、血清炎性因子水平及预后的影响研究

Impact of Rosuvastatin on Vascular Endothelial Function,Serum Inflammatory Cytokines Levels and Prognosis of ACS Patients Treated by PCI

目的探讨瑞舒伐他汀对急性冠脉综合征(ACS)患者经皮冠状动脉介入(PCI)术后血管内皮功能、血清炎性因子水平及预后的影响。方法选取徐州市中心医院2012年4月—2013年5月收治的ACS患者114例,按照随机数字表法分为观察组和对照组,各57例。两组患者均接受择期PCI治疗,对照组患者给予常规药物治疗,观察组患者在对照组基础上给予瑞舒伐他汀治疗。比较两组患者术日清晨、术后24 h及术后1个月血管内皮功能指标〔血管性假血友病因子(v WF)、内皮素-1(ET-1)及一氧化氮(NO)〕,术日清晨和术后1个月血清炎性因子〔可溶性细胞黏附分子-1(s ICAM-1)、基质金属蛋白酶9(MMP-9)及超敏C反应蛋白(hs-CRP)〕水平及预后〔近期预后:术日清晨和术后1个月左心室射血分数(LVEF);远期预后:PCI术后1年内心血管事件及支架内再狭窄发生情况〕。结果两组患者术日清晨及术后24 h血清v WF、ET-1及NO水平比较,差异均无统计学意义(P>0.05);术后1个月观察组患者血清v WF和ET-1水平低于对照组,血清NO水平高于对照组(P<0.05)。术日清晨两组患者血清s ICAM-1、MMP-9及hs-CRP水平比较,差异无统计学意义(P>0.05);术后1个月观察组患者血清s ICAM-1、MMP-9及hs-CRP水平低于对照组(P<0.05)。术日清晨两组患者LVEF比较,差异无统计学意义(P>0.05);术后1个月观察组患者LVEF高于对照组(P<0.05)。术后1年观察组患者再发心绞痛、恶性心律失常、心力衰竭、心源性猝死发生率及支架内再狭窄发生率均低于对照组(P<0.05)。结论瑞舒伐他汀能有效改善ACS患者PCI术后血管内皮功能,有效抗炎,改善患者近期及远期预后。

Objective To investigate the impact of rosuvastatin on vascular endothelial function,serum inflammatory cytokines levels and prognosis of ACS patients treated by PCI.Methods A total of 114 ACS patients were selected in Xuzhou Central Hospital from April 2012 to May 2013,and they were divided into control group and observation group according to random number table,each of 57 cases.Patients of both groups were treated by delayed PCI,and patients of control group received conventional drugs,while patients of observation group received extra rosuvastatin based on conventional drugs.Index of vascular endothelial function（including serum levels of v WF,ET-1 and NO）in the morning of operative day,24 hours after PCI and 1 month after PCI,serum inflammatory cytokines levels（including serum levels of s ICAM-1,MMP-9 and hs-CRP）in the morning of operative day and 1 month after PCI,and prognosis（LVEF in the morning of operative day and 1 month after PCI,incidence of cardiovascular events and in-stent restenosis after 1 year of PCI）were compared between the two groups.Results No statistically significant differences of serum level of v WF,ET-1 or NO was found between the two groups in the morning of operative day or 24 hours after PCI（P〉0.05）; 1 month after PCI,serum levels of v WF and ET-1 of observation group were statistically significantly lower than those of control group,while serum NO level of observation group was statistically significantly higher than that of control group（P〈0.05）.No statistically significant differences of serum level of s ICAM-1,MMP-9 or hs-CRP was found between the two groups in the morning of operative day（P〉0.05）,while serum levels of s ICAM-1,MMP-9 and hs-CRP of observation group were statistically significantly lower than those of control group1 month after PCI（P〈0.05）.No statistically significant differences of LVEF was found between the two groups in the morning of operative day（P〉0.05）,while LVEF of observation group was statistically significantly higher than that of control group 1month after PCI（P〈0.05）.After 1 year of PCI,the incidence of recurrent angina pectoris,malignant arrhythmia,heart failure,sudden cardiac death and in-stent restenosis of observation group was statistically significantly lower than that of control group,respectively（P〈0.05）.Conclusion Rosuvastatin can effectively improve the vascular endothelial function,near term and long term prognosis of ACS patients treated by PCI,reduce the serum inflammatory cytokines levels,has certain anti-inflammatory action.