强化他汀类药物治疗对急性冠脉综合征患者经皮冠状动脉介入治疗后炎症-凝血网络的影响

Effect of statin intensive treatment on inflammation-coagulation network in patients with acute coronary syndrome undergoing percutaneous coronary intervention

目的通过观察不同剂量阿托伐他汀对急性冠状动脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后炎性因子及凝血系统的影响,深入探讨阿托伐他汀在ACS二级预防中的作用。方法入选2015年1月至2017年1月于北京市海淀医院行PCI治疗的ACS患者380例,随机分为常规治疗组120例(阿托伐他汀术前20 mg/d,术后10 mg/d)、中剂量组120例(阿托伐他汀术前40 mg/d,后20 mg/d)及高剂量组140例(阿托伐他汀术前80 mg/d,术后40 mg/d),另外入选同期50例行冠状动脉造影术正常者作对照组,观察治疗前、治疗后1个月和3个月患者血脂浓度、血清炎症因子如阿托伐他汀超敏C-反应蛋白(high-sensitivity C-reactive protein,hs-CRP)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和白细胞介素-6(interleukin-6,IL-6)以及凝血指标组织因子(tissue factor,TF)、组织因子途径抑制物(tissuefactor pathway inhibitor,TFPI)浓度。临床随访6个月记录并比较不良反应发生率及主要不良心血管事件(ma-jor adverse cardiovascular events,MACE)发生率。结果治疗前3组ACS患者炎症因子hs-CRP、TNF-α、IL-6及凝血因子TF浓度均高于正常对照组,而TPIF浓度明显降低,差异均有统计学意义(P<0.05);治疗1个月后,高剂量组炎症因子及TF较治疗前均明显降低,凝血因子TFPI浓度较治疗前升高,中剂量组仅hs-CRP浓度降低,差异有统计学意义(P均<0.05);治疗3个月后,中、高剂量组炎症因子水平及TF浓度均明显降低,TFPI浓度则显著升高,差异有统计学意义(P<0.05和P<0.01)。治疗1个月、3个月后3组不良反应发生率比较,差异无统计学意义(P>0.05);而高剂量组MACE发生率均明显降低,差异有统计学意义(P<0.05)。结论强化他汀治疗能够显著降低血浆炎症因子浓度,升高凝血因子TFPI浓度,降低MACE发生率,且不增加不良反应发生。

Objectives To explore the role of statin intensive treatment in the secondary prevention of acute coronary syndrome(ACS)by observing the effects of different doses of atorvastatin on inflammation-coagulation network in patients with ACS undergoing percutaneous coronary intervention(PCI).Methods Three hundreds and eighty ACS patients who underwent PCI between January 2015 and January 2017 were randomly divided into three groups:conventional group(n=120),which was treated with atorvastatin 20 mg/d before PCI and 10 mg/d after,moderate dose group(n=120),which was treated with atorvastatin 40 mg/d before PCI and 20 mg/d after,and high dose group(n=140),which was treated with atorvastatin 80 mg/d before PCI and 40 mg/d after.From the same term,50 objects with normal coronary angiography were enrolled in control group.Serum concentrations of lipoprotein,highsensitivity Creactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),tissue factor(TF)and tissue factor pathway inhibitor(TFPI)were measured before(baseline)and after 1 and 3 months′treatment.Incidence of adverse reaction and major adverse cardiovascular events(MACE)were observed during 6-month follow-up.Results Before treatment,plasma concentrations of hs-CRP,TNF-α,IL-6 and TF were higher in ACS groups compared with control group,while concentration of TPIF was lower(all P<0.05).After 1 month of treatment,plasma concentrations of hs-CRP,TNF-α,IL-6 and TF reduced in the high dose group while the concentration of TPIF was higher,but only concentration of hs-CRP reduced in moderate dose group(P<0.05).Concentrations of inflammatory factors and TF were reduced in moderate and high dose group after 3 months,while concentration of TPIF was higher(P<0.05 and P<0.01).There were no significant differences in adverse reaction among the three ACS groups after treatment for 1 and 3 months(P>0.05).However,incidence of MACE declined in high dose group.Conclusions Intensive statin therapy can significantly reduce concentration of plasma inflammatory factors,increase concentration of coagulation factor TFPI,reduce incidence of MACE,and does not increase adverse reactions.