急性冠状动脉综合征患者PCI术后应用瑞百安对血管内皮功能的影响

Effect of Repatha on vascular endothelial function in patients with acute coronary syndrome after PCI

目的观察瑞百安对急性冠状动脉综合征(ACS)患者PCI术后血管内皮功能的影响。方法选取2018年10月—2019年4月武汉亚洲心脏病医院心内科CCU行PCI术治疗ACS患者100例,按随机数字表法分为观察组和对照组各50例。2组均给予扩张冠状动脉、β受体阻滞剂及相关危险因素控制等常规治疗,对照组加服阿托伐他汀,观察组在对照组基础上增加瑞百安皮下注射治疗。比较2组患者治疗前后血管内皮功能、炎性因子、血脂差异,并记录2组患者治疗后不良心血管事件发生率。结果与PCI术前比较,PCI 24 h后2组患者vWF、ET-1指标升高,NO水平降低(P<0.01);治疗1个月后,观察组vWF、ET-1水平低于对照组,NO水平高于对照组(t=5.614、13.705、6.121,P均=0.000)。与PCI术前比较,PCI 24 h后2组患者TNF-α、IL-6、CRP水平均显著升高(P<0.01);治疗1个月后,2组患者TNF-α、IL-6、CRP水平显著降低,且观察组低于对照组(t=8.039、8.983、4.806,P均=0.000)。与治疗前比较,治疗1个月后2组患者TC、TG、LDL-C水平均显著降低,HDL-C水平显著升高,且观察组患者TC、TG、LDL-C水平显著低于对照组,HDL-C水平显著高于对照组(t=5.852、6.051、9.114、4.080,P均=0.000)。治疗期间观察组主要心血管不良事件发生率为2.00%,显著低于对照组的14.00%(χ^2=4.891,P=0.027)。结论瑞百安能够有效降低ACS患者PCI术后心血管不良事件发生率,改善血管内皮功能,降低血脂水平,减轻炎性反应。

Objective To observe the effect of Repatha on the vascular endothelial function of patients with acute coronary syndrome(ACS)after PCI.Methods From October 2018 to April 2019,100 patients with ACS were treated with PCI in the CCU of the Department of Cardiology,Wuhan Asia Heart Hospital,and were divided into observation group and control group with 50 cases each according to the random number table.Both groups were given conventional treatments such as coronary artery dilation,β-blockers and related risk factors control.The control group was given atorvastatin,and the observation group was given subcutaneous injection of Repatha on the basis of the control group.The differences in vascular endothelial function,inflammatory factors,and blood lipids between the two groups of patients before and after treatment were compared,and the incidence of adverse cardiovascular events after the treatment was recorded.Results Compared with pre-PCI,the vWF and ET-1 indexes of the 2 groups increased and NO levels decreased(P<0.01)after PCI 24 hours;after 1 month of treatment,the observation group had lower vWF and ET-1 levels than the control group,and NO Higher than the control group(t=5.614,13.705,6.121,all P=0.000).Compared with pre-PCI,the levels of TNF-α,IL-6,and CRP in the two groups were significantly increased 24 hours after PCI(P<0.01);after 1 month of treatment,the levels of TNF-α,IL-6,and CRP in the two groups were significantly reduced,And the control group of the observation group(t=8.039,8.983,4.806,P=0.000).Compared with before treatment,1 month after treatment,the levels of TC,TG,LDL-C of the two groups were significantly reduced,and the levels of HDL C were significantly increased.The levels of TC,TG,and LDL-C of the observation group were significantly lower than those of the control group.The level was significantly higher than that of the control group(t=5.852,6.051,9.114,4.080,all P=0.000).During the treatment period,the incidence of major cardiovascular adverse events in the observation group was 2.00%,which was significantly lower than the 14.00%in the control group(χ^2=4.891,P=0.027).Conclusion Repatha can effectively reduce the incidence of cardiovascular adverse events in ACS patients after PCI,improve vascular endothelial function,reduce blood lipid levels,and reduce inflammatory reactions.