不同剂量替格瑞洛联合阿托伐他汀钙片对冠心病UAP患者血液流变学心功能及血清MMP-9 IGF-1的影响

Effects of Different Doses of Ticagrelor Combined with Atorvastatin Calcium Tablets on Hemorheology Cardiac Function and Serum MMP-9 and IGF-1 in Patients with Coronary Heart Disease UAP

目的:探究不同剂量替格瑞洛联合阿托伐他汀钙片对冠心病不稳定型心绞痛(Unstable Angina Pectoris,UAP)患者血液流变学、心功能及血清基质金属蛋白酶9(matrix metalloprotein-9,MMP-9),胰岛素样生长因子1(insulin-like growth factors-1,IGF-1)的影响。方法:前瞻性选取2020年11月至2021年11月在本院接受治疗的117例冠心病UAP患者作为研究对象,采用掷硬币法简单随机分为A、B组,最终纳入A组61例、B组56例,B组患者在常规治疗基础上给予90mg替格瑞洛+阿托伐他汀钙片治疗,A组患者在常规治疗基础上给予45mg替格瑞洛+阿托伐他汀钙片治疗,两组患者均连续治疗1个月。比较两组患者治疗前、治疗1个月后血液流变学(全血黏度(whole blood viscosity,WBV)、血浆黏度(plasma viscosity,PV))、心功能(左心室射血分数(Left Ventricular Ejection Fractions,LVEF)、左心室舒张内径(left ventricular end diastolic diameter,LVEDD)、心脏室间隔厚度(interventricular septum thickness,IVST))及血清MMP-9、IGF-1水平的变化。结果:重复测量方差结果显示,两组患者治疗不同时点WBV、PV水平以时间因素为源、以组别为源的主体间效应及以时间与组别交互为源的主体内效应间比较具有统计学意义,P<0.05;治疗1个月后,两组患者WBV、PV水平均下降且A组低于B组,P<0.05;重复测量方差结果表明,两组患者治疗不同时点LVEF、LVEDD、IVST水平以时间因素为源、以组别为源的主体间效应及以时间与组别交互为源的主体内效应间比较具有统计学意义,P<0.05;治疗1个月后,两组患者LVEF水平均上升且A组高于B组,LVEDD、IVST水平均下降且A组低于B组,P<0.05;重复测量方差结果表明,两组患者治疗不同时点MMP-9、IGF-1水平以时间因素为源、以组别为源的主体间效应及以时间与组别交互为源的主体内效应间比较具有统计学意义,P<0.05;治疗1个月后,两组患者MMP-9水平均下降且A组低于B组,IGF-1水平均上升且A组高于B组,P<0.05。结论:不同剂量替格瑞洛联合阿托伐他汀钙片对冠心病UAP患者均有一定的治疗效果,但使用少剂量组患者的血液流变学及心功能改善效果较好,能够明显降低MMP-9并提高IGF-1水平,值得临床参考借鉴。

Objective:To explore the effects of different doses of ticagrelor combined with atorvastatin calcium tablets on hemorheology,cardiac function and serum matrix metalloprotein-9(MMP-9),the effect of insulin-like growth factors-1(IGF-1).Methods:A total of 117 patients with coronary heart disease UAP who were treated in our hospital from November 2020 to November 2021 were prospectively selected as the research subjects,and were divided into groups A and B by simple random coin tossing method,and finally 61patients in group A and 56 patients in group B were included.The patients in group B were given 90mg ticagrelor+atorvastatin calcium tablets on the basis of conventional treatment,and the patients in group A were given 45mg ticagrelor+atorvastatin calcium tablets on the basis of conventional treatment,the two groups of patients were treated continuously for 1 month.The rheology(whole blood viscosity(WBV),plasma viscosity(PV)),cardiac function(left ventricular ejection fractions(LVEF),left ventricular end diastolic diameter(LVEDD)and serum MMP-9,LVEDD were compared between the two groups before and after 1 month of treatment(LVEF),left ventricular end diastolic diameter(LVEDD),interventricular septum thickness(IVST))and serum MMP-9 and IGF-1 levels.Results:The results of repeated measures variance showed that the comparison between the WBV and PV levels at different points of treatment in both groups was statistically significant with time factor as the source,between-subjects effect with group as the source and withinsubjects effect with time and group interaction as the source,P<0.05;after 1 month of treatment,the WBV and PV levels decreased in both groups and were lower in group A than in group B,P<0.05;The results of repeated measurement variance showed that the comparison of LVEF,LVEDD,and IVST levels at different points of treatment in both groups was statistically significant with time factor as the source,between-subjects effect with group as the source and within-subjects effect with time and group interaction as the source,P<0.05;after 1 month of treatment,LVEF levels increased in both groups and were higher in group A than in group B,LVEDD and IVST levels decreased and were lower in group A than in group B,P<0.05.Repeated measurement variance results showed that the two groups of patients were not treated well.At the same time,the MMP-9 and IGF-1 levels at the same time points were compared between the inter-subject effect with the time factor as the source,the group as the source,and the intra-subject effect with the interaction between time and group as the source,P<0.05;after one month treatment,the levels of MMP-9 in both groups decreased and lower in group A than in group B,while the levels of IGF-1 increased and higher in group A than in group B,P<0.05.Conclusion:Different doses of ticagrelor combined with atorvastatin calcium tablets have certain therapeutic effects on patients with coronary heart disease UAP,but the patients in the low-dose group have better improvement in blood rheology and cardiac function,and can significantly reduce MMP-9 And improve the level of IGF-1,which is worthy of clinical reference.