摘要
背景:有研究表明选择性环氧合酶-2(COX-2)抑制剂可引起心脏事件风险增加,因此其在心血管疾病患者中应用的安全性受到质疑。本研究观察非ST段抬高型急性冠状动脉综合征患者应用选择性COX-2抑制剂罗非昔布后在内皮功能、氧化损伤和炎症方面的短期效应。方法:研究共纳入43例非ST段抬高型急性冠状动脉综合征患者。
Background: The safe use of selective inhibitors of cyclooxygenase-2 in patients with cardiovascular disease has been questioned because of studies showing an increased risk of cardiac events. We examined the short-term effect of rofecoxib, a selective cyclooxygenase-2 inhibitor, on endothelial function, oxidative damage and inflammation in patients with acute coronary syndromes without ST-segment elevation. Methods: Forty-three patients with acute coronary syndromes without ST-segment elevation participated in the study. Flow-mediated dilatation(FMD), nitrate-mediated dilatation(NMD) of the brachial artery, malondialdehyde, a marker of lipid peroxidation, C-reactive protein, an acute phase marker of inflammation, and interleukin-6, a proinflammatory cytokine, were measured within 24 h of admission and a week later. Patients were randomized to receive for a week 100 mg aspirin daily with either 25 mg of rofecoxib(n=21) or placebo(n=22) orally once daily. Results: Malondialdehyde,C-reactive protein and interleukin-6 levels were reduced in the rofecoxib group(p=0.04, p=0.003 and p=0.02 respectively) while they remained unchanged in the placebo group after 1 week of treatment. FMD and NMD changes in both groups were not statistically different. Conclusions: Co-administration of rofecoxib with low-dose aspirin decreases inflammatory and oxidative indices but does not improve endothelial function. The lack of improvement in FMD despite the improvement in inflammation and oxidative stress could be viewed in association to the recent observations on the adverse effects of COX-2 inhibition on the cardiovascular system.
