阿托伐他汀钙联合氯吡格雷对不稳定型心绞痛患者血脂及血管内皮舒张功能的影响机制

Effect mechanism of diastolic function of atorvastatin combined with clopidogrel on blood lipid and vascular endothelium in patients with unstable angina pectoris

目的研究阿托伐他汀钙联合氯吡格雷对不稳定型心绞痛患者血脂及血管内皮舒张功能的影响机制。方法选择2014年12月~2015年12月期间北京丰台医院收治的不稳定型心绞痛患者60例,采用随机数字表法将所有患者随机分为观察组和对照组,每组各30例,两组患者均予常规治疗,观察组在此基础上联合阿托伐他汀钙、氯吡格雷治疗,对两组治疗后的效果进行对比分析,同时比较两组患者治疗前后胆固醇（TC）、三酰甘油（TG）、低密度脂蛋白胆固醇（LDL-C）水平、高密度脂蛋白胆固醇（HDL-C）水平及血管内皮舒张功能指标血管内皮依赖性舒张功能（FMD）、非依赖性血管内皮舒张功能（NMD）、血清一氧化氮（NO）水平、内皮素（ET）的变化情况。结果观察组治疗后的总有效率为96.7%,与对照组的总有效率（70.0%）比较差异有统计学意义（P〈0.05）。观察组治疗后的TC、TG、LDL-C水平显著低于对照组（P〈0.05）,而观察组的HDL-C水平与对照组比较差异无统计学意义（P〉0.05）。观察组治疗后的FMD水平显著高于对照组（P〈0.05）,观察组的NO水平较对照组升高,差异有统计学意义（P〈0.01）,观察组的ET水平较对照组降低极显著（P〈0.01）,而观察组的NMD水平与对照组比较差异无统计学意义（P〉0.05）。结论阿托伐他汀钙联合氯吡格雷可以显著提高不稳定型心绞痛患者的临床效果,显著降低血脂水平,考虑可能与其改善血管内皮舒张功能密切相关。

Objective To study the effect mechanism of atorvastatin combined with clopidogrel on blood lipid and vascular endothelial diastolic function in patients with unstable angina pectoris. Methods 60 cases of unstable angina pectoris patients from December 2014 to December 2015 in Beijing Fengtai Hospital were selected and randomly divided into observation group and control group, with 30 cases in each group, two groups of patients were given conventional treatment, observation group were combined with atorvastatin and clopidogrel treatment, the contrast analysis to the curative effect after the treatment in the two groups was carried on, and patients with blood lipid and vascular endothelial diastolic function indexes changes were compared between two groups before and after treatment. Results The total effective rate of the observation group after treatment was 96.7%, and the total effective rate of the control group was70%, there was significant difference（P 0.05）. The TC, TG and LDL-CD levels in the observation group were significantly lower than those in the control group（P 0.05）, while the HDL-C level of the observation group was not significantly different from the control group（P 0.05）. The observation group after treatment, the level of FMD was significantly higher than that in the control group（P 0.05）, in comparison with the control group, it increased very significantly in the observation group（P 0.01）, the level of NO, ET level in the observation group was significantly lower than those in the control group（P 0.01）, and there was no difference of control in the observation group of NMD and contrast group（P 0.05）. Conclusion Atorvastatin combined with clopidogrel can significantly improve the clinical efficacy of patients with unstable angina and decrease lipid level, taking that it is closely related to improve vascular endothelial diastolic function.