不同他汀对急性冠状动脉综合征患者炎症和凋亡反应的作用

Effect of different statins on inflammatory and apoptotic responses in ACS patients

目的:探讨不同他汀药物对于急性冠状动脉综合征(acute coronary syndrome,ACS)患者的炎症和凋亡反应的作用机制。方法:选取本院收治的80例ACS患者,随机分为两组,A组(常规治疗联合瑞舒伐他汀组10 mg,n=40),B组(常规治疗联合阿托伐他汀20 mg,n=40),并选取同期于本院体检正常人员作为C组(对照组,n=50)。采用酶联免疫吸附法(ELISA)检测治疗前后各组患者血清中人肿瘤坏死因子α(TNF-α)、白介素1β(IL-1β)、Bcl-2、c-myc癌基因产物的表达水平变化;比较治疗前后各组的高敏C反应蛋白(high-sensitivity C-reactive protein,hs-CRP),总胆固醇(total cholesterol,TC)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)、高密度脂蛋白胆固醇(high density lipoprotein cholesterol,HDL-C)水平。结果:1他汀治疗后A,B两组TC,LDL-C浓度水平均显著降低(P<0.05);且A组的TC和LDL降低较B组更明显(P<0.05);2治疗后A、B两组患者血清CRP、TNF-α、IL-1β、c-myc浓度均有显著下降(P<0.05),Bcl-2浓度显著升高(P<0.05),但A、B两组之间的差异无统计学意义(P>0.05)。10 mg瑞舒伐他汀和20 mg阿托伐他汀均能明显降低ACS患者血清TC、LDL水平,前者更显著;两组他汀均能降低血清CRP、TNF-α、IL-1β、c-myc蛋白浓度,并使Bcl-2蛋白浓度显著升高,且两者疗效相当。结论:他汀类药物除能有效调脂作用外,还能通过降低CRP、TNF-α、IL-1β、c-myc蛋白浓度,升高Bcl-2蛋白浓度发挥抗炎、抗凋亡的作用。

Objective： To explore the mechanism of different statins on inflammatory and apoptotic responses in patients with acute coronary syndrome（ ACS）. Methods： 80 cases of ACS were selected in our hospital and randomly divided into two groups,A group（ rosuvastatin 10 mg combined conventional therapy,n = 40）,B group（ atorvastatin 20 mg combined conventional therapy,n = 40） and we selected 50 healthy persons for medical examination in our hospital at the same period（ C group,n = 50）. The serum level of TNF-α,IL-1β,Bcl-2,c-myc were detected using ELISA kit. Levels of high-sensitivity C-reactive protein（ hs-CRP）,total cholesterol（ TC）,low density lipoprotein cholesterol（ LDL-C） and high density lipoprotein cholesterol（ HDL-C） were detected before and after treatment. Results： After treatment TC,LDL-C levels of A,B two groups were decreased（ P〈0. 05）,and the A group had significantly better descender than that of B group.（ P〈0. 05）. After treatment,the serum concentrations between A and B groups of CRP,TNF-α,IL-1β,c-myc decreased significantly（ P〈0. 05）,and the serum concentration of Bcl-2 significantly increased（ P〈0. 05）,but the difference between A and B is no statistically significant（ P〉0. 05）. About the treatment with ACS,10 mg rosuvastatinis better than 20 mg atorvastatinin reduced the serum TC,LDL. Rosuvastatin and atorvastatin can reduce CRP,TNF-α,IL-1β and c-myc concentration,but increase Bcl-2 protein concentration,the two groups has the similar effects. Conclusion： In addition to lipid regulation,statins may reduce the concentration of CRP,TNF-α,IL-1β and c-myc protein,and increase the concentration of Bcl-2 protein to exert anti-inflammatory and anti apoptotic effects.