阿托伐他汀联合氯毗格雷对不稳定型心绞痛患者超敏C-反应蛋白及预后的影响

Influences of atorvastatin combined with clopidogrel on hypersensitive C-reactive protein and prognosis of patients with unstable angina pectoris

目的观察阿托伐他汀联合氯毗格雷治疗对不稳定型心绞痛患者临床疗效和对超敏C-反应蛋白(hs-CRP)及预后的影响。方法收集唐山工人医院2013年1月至2017年12月收治的430例不稳定型心绞痛患者的临床资料,根据服药种类将患者分为对照组与观察组,每组215例。两组均给予常规治疗;对照组在常规治疗基础上给予肠溶阿司匹林(初始剂量为300 mg,维持剂量100 mg/d)同时口服阿托伐他汀(20 mg、每日1次),皮下注射4.1 kU低分子肝素钙,每隔12 h 1次,共7 d;观察组在常规治疗基础上口服阿托伐他汀(20 mg.每日1次)同时给予了氯毗格雷(初始剂量为30 mg潍持剂量为75 mg/d).两组均治疗6个月后评价临床疗效。比较两组治疗前后总胆固醇(TC)、三酰甘油(TG)、hs-CRP的差异,并观察两组临床疗效及用药不良反应发生率。结果观察组治疗后总有效率明显高于对照组〔92.56%(199/2⑸比73.48%(158/215),P<0.05〕。两组治疗后TC、TG及hs-CRP水平均较治疗前降低,且观察组治疗后上述指标均明显低于对照组[TC(mmol/L):2.28±0.29 比 3.81 ± 1.33, TG(nunol/L): 4.35±0.32 比 7.77±0.24, hs-CRP(mg/L): 5.41 ±2.26比7.15±3.22,均P<0.05〕。观察组和对照组不良反应发生率比较差异无统计学意义[7.91%(17/215)比10.25%(22/215), P>0.05〕。结论阿托伐他汀联合氯毗格雷用于治疗不稳定型心绞痛,可有效降低hs-CRP水平,减轻炎症反应的刺激作用,对改善患者预后有重要意义。

Objective To observe clinical efficacy of atorvastatin combined with clopidogrel for treatment of patients with unstable angina and its influences on hypersensitive C-reactive protein (hs-CRP) and prognosis of such patients. Methods Data of four hundred and thirty patients with unstable angina pectoris admitted to Tangshan Worker's Hospital from January 2013 to December 2017 were collected, and according to difference in drug application, they were divided into control group and observation group, with 215 patients in each group. Both groups were treated with routine western therapy;the patients in the control group were subjected to enteric-coated aspirin (the initial dose was 300 mg and the maintenance dose 100 mg/d) atorvastatin therapy (20 mg orally taken, once a day) on the basis of conventional therapy, subcutaneous injection of 4.1 kU low molecular weight heparin calcium every 12 hours once time for 7 days;the patients in the observation group were subjected toatorvastatin therapy (similar dosage used in the control group) and clopidogrel therapy (the initial dose was 30 mg and the maintenance dose was 75 mg/d) on the basis of conventional treatment. After both groups were treated for 6 months, their clinical efficacies were evaluated. The differences of cholesterol (TC), triac.ylglycerol (TG), hs-CRP were compared before and after treatment between the two groups, and the clinical curative effect, and drug adverse reaction were observed in the two groups. Results After treatment, the total effective rate of the observation group was significantly higher than that of the control group [92.56%(199/215) vs. 73.48%(158/215), P < 0.05, P < 0.05]. After treatment, the levels of TC, TG and hs-CRP in the two groups were lower than those before treatment, and the above indexes in the observation group were significantly lower than those in the control group [TC (mmol/L): 2.28 ±0.29 vs. 3.81 ± 1.33, TG (mmol/L): 4.35 ±0.32 vs. 7.77 ± 0.24, hs-CRP (mg/L): 5.41 ±2.26 vs. 7.15 ± 3.22, all P < 0.05].There was no significant difference in the incidence of adverse reactions between the observation group and the control group [7.91%(17/215) vs. 10.25%(22/215), P > 0.0习. Conclusion Atorvastatin combined with clopidogrel for treatment of unstable angina pectoris can effectively lower the level of hs-CRP,and it has important significance for improving the prognosis of such patients.