中等剂量阿托伐他汀治疗急性冠脉综合征对血管内皮功能及不良心血管事件影响

Effect of medium dose atorvastatin on vascular endothelial function and adverse cardiovascular events in patients with acute coronary syndrome

目的探讨中等剂量阿托伐他汀治疗对急性冠脉综合征(ACS)患者血管内皮功能及不良心血管事件的影响。方法选取2017-02-01-2020-02-01中牟县人民医院收治的80例ACS患者为研究对象。根据阿托伐他汀使用剂量分成低剂量组(20mg/d)25例、中剂量组(60mg/d)29例和高剂量组(80mg/d)26例。比较3组患者血管内皮功能、血脂水平、心功能和不良心血管事件发生情况。结果治疗后,3组患者血管内皮生长因子(VEGF)水平较治疗前升高,内皮肤-1(ET-1)水平较治疗前降低,其中低剂量组VEGF水平最低、ET-1水平最高。治疗后,低剂量组VEGF、ET-1水平分别为(401.47±32.87)pg/mL和(56.87±7.15)ng/mL;中剂量组分别为(468.25±32.81)pg/mL和(43.01±7.19)ng/mL;高剂量组分别为(468.32±32.83)pg/mL和(43.03±7.13)ng/mL。3组患者治疗后VEGF、ET-1水平比较,差异有统计学意义,均P<0.001。治疗后,低剂量组低密度脂蛋白(LDL)、总胆固醇(TC)水平分别为(2.84±0.17)和(3.68±0.34)mmol/L;中剂量组分别为(1.87±0.15)和(3.21±0.39)mmol/L;高剂量组分别为(1.85±0.14)和(3.22±0.35)mmol/L。3组患者治疗后LDL、TC水平比较,差异有统计学意义,均P<0.001。治疗后,低剂量组左心室收缩末期内径(LVSD)、左心室射血分数(LVEF)值分别为(54.18±4.15)mm和(46.58±2.14)%;中剂量组分别为(50.87±4.18)mm和(48.99±2.19)%;高剂量组分别为(50.83±4.13)mm和(48.03±2.17)%。3组患者治疗后LVSD值和LVEF值较治疗前升高,且低剂量组LVSD值最高、LVEF值最低;3组患者治疗后LVSD、LVEF值比较差异有统计学意义,均P<0.05。3组患者不良心血管事件发生率分别为28.00%、10.45%和15.38%,差异无统计学意义,χ^(2)=3.018,P=0.221。结论中等剂量阿托伐他汀在治疗安全地基础上,能最大限度的改善ACS患者血管内皮功能和心功能,降低血脂。

Objective To investigate the effect of medium dose atorvastatin on vascular endothelial function and adverse cardiovascular events in patients with acute coronary syndrome(ACS).Methods 80 patients with ACS treated in Zhongmou County People’s Hospital from February 1,2017 to February 1,2020 were selected as the research objects.Divided into three groups according to different doses of atorvastatin,low dose group(20 mg/d,n=25),medium dose group(60 mg/d,n=29)and high dose group(80 mg/d,n=26).Then the vascular endothelial function,blood lipid level,cardiac function and adverse cardiovascular events were compared among three groups.Results After treatment,there was an increase in vascular endothelial growth factor(VEGF)level and a decrease in endothelin-1(ET-1)level.Comparison showed that the low dose group had the lowest VEGF level and highest ET-1 level.Levels of VEGF and ET-1 were(401.47±32.87)pg/ml and(56.87±7.15)ng/ml in low-dose group,(468.25±32.81)pg/ml and(43.01±7.19)ng/ml in medium-dose group,and were(468.32±32.83)pg/ml and(43.03±7.13)ng/ml in high-dose group,with statistical difference(P<0.001).After treatment,there was a decrease in levels of low density lipoprotein(LDL)and cytotoxic T cell(TC),and the levels were the highest in low dose group.Levels of LDL and TC were(2.84±0.17)and(3.68±0.34)mmol/l in low-dose group,(1.87±0.15)and(3.21±0.39)mmol/l in medium-dose group,and were(1.85±0.14)and(3.22±0.35)mmol/l in high-dose group,with statistical difference(P<0.001).After treatment,there was an increase in left ventricular ejection fraction(LVEF)and a decrease in left ventricular end diastolic(LVSD).Low dose group had the lowest LVEF and highest LVSD.Values of LVSD and LVEF were(54.18±4.15)mm and(46.58±2.14)%in lowdose group,(50.87±4.18)mm and(48.99±2.19)%in medium-dose group,and were(50.83±4.13)mm and(48.03±2.17)%in high-dose group,with statistical difference(P<0.05).The rate of adverse cardiovascular events was 28.00%,10.45%and 15.38%in three group,with no statistical difference(χ^(2)=3.018,P=0.221).Conclusion Medium dose atorvastatin can effectively and safely improve the endothelial function and cardiac function of ACS patients,and reduce blood lipid,which is worthy of recommendation.