盐酸法舒地尔治疗冠状动脉慢血流疗效及对相关血浆因子的影响

Clinical efficacy of fasudil in the treatment of coronary slow flow and its effects on levels of correlated plasma factors

目的 探讨盐酸法舒地尔对冠状动脉慢血流(coronary slow lfow,CSF)患者的临床疗效及对血浆高敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)、单核细胞趋化蛋白-1(monocyte chemotactic protein-1,MCP-1)、内皮素-1(endothelin-1,ET-1)、Rho激酶Ⅰ(Rho kinase I,ROCKⅠ)水平的影响.方法 选择因胸痛住院行冠状动脉造影检查结果正常但存在CSF现象的82例患者,分为法舒地尔治疗组(41例)与常规治疗组(41例).常规治疗组给予阿司匹林肠溶片(每晚口服0.1 g)、阿托伐他汀(每晚口服20 mg)、单硝酸异山梨酯片(口服20 mg,2次/d)常规治疗,法舒地尔组在常规治疗基础上给予盐酸法舒地尔治疗(60 mg静滴,1次/d).观察两组患者治疗前及治疗后2周的心绞痛发作次数、心电图检查情况、冠状动脉血流速度以及hs-CRP、MCP-1、ET-1、ROCKⅠ水平的变化.组间及组内治疗前后hs-CRP、MCP-1、ET-1、ROCKⅠ的比较均采用t检验,组间率的比较用χ2检验.结果 以心绞痛发作情况判定疗效:法舒地尔治疗组治疗总有效率明显高于常规治疗组,差异有统计学意义(87.80%、65.85%,χ2=68.176,P<0.05);以心电图检查情况判定疗效:法舒地尔治疗组治疗总有效率明显高于常规治疗组,差异有统计学意义(82.92%、58.84%,χ2=60.463,P<0.05).两组患者治疗后TIMI血流帧数均值均较治疗前明显下降,且法舒地尔组下降更明显,差异均有统计学意义(t=4.376、0.353,P<0.05或0.01);治疗后法舒地尔治疗组TIMI血流帧数均值较常规治疗组显著下降,差异有统计学意义(t=5.236,P<0.01).法舒地尔治疗组患者治疗后血浆hs-CRP、MCP-1、ET-1、ROCKⅠ水平均明显低于治疗前,差异均有统计学意义(t=6.049、5.294、5.662、6.191,P<0.05或0.01);治疗后法舒地尔组患者血浆hs-CRP、MCP-1、ET-1、ROCKⅠ水平均较常规治疗组患者显著降低,差异均有统计学意义(t=3.958、4.496、4.363、3.875,均P<0.01).结论 盐酸法舒地尔不仅可以改善患者心绞痛症状,同时还能通过抑制炎症反应、改善血管内皮功能,提高CSF患者的冠状动脉血流速度.

Objective To investigate the efficacy of fasudil in the treatment of coronary slow flow and its effect on hs-CRP、MCP-1、ET-1 and ROCK Ⅰ. Methods Eighty two patients with CSF and normal coronary angiography were selected. Patients were randomly divided into conventional treatment group and fasudil group, 41 cases in each group. Patients in conventional treatment group were given conventional treatment(aspirin, nitrates and Simvastatin), while patients in the fasudil group were given fasudil on the basis of conventional treatment. The frequency of angina pectoris, ECG, TIMI, the plasma levels of hs-CRP, MCP-1、ET-1、ROCK Ⅰ were observed in the two groups before and after two weeks of treatment. Student t-test was applied to compare the difference of pre-and posttreatment hs-CRP、MCP-1、ET-1 and ROCK Ⅰ levels within and between pre-and post-treatment, Chi-square was applied to compare the difference between groups. Results Improvement of clinical symptoms: the total effective rate of fasudil group was 87.80%,higher than of control group of 65.85%(χ~2=68.176, P<0.05). Improvement of ECG: the total effective rate of fasudil group was 82.92%,higher than of control group of 58.84%(χ~2=60.463, P<0.05). TIMI improved significantly in the two group post-treatment compared with pre-treatment with t values of(t=4.376, 0.353 and P<0.05, 0.01). TIMI improved significantly in the fasudil group after treatment compared with conventional therapy group after treatment with t values of 5.236(P<0.01). The peripheral blood levels of hs-CRP, MCP-1、ET-1、ROCK Ⅰ in fasudil treatment group were significantly reduced compared with pre-treatment(t=6.049, 5.294, 5.662, 6.191 and P<0.05 or 0.01). The pre-treatment hs-CRP, MCP-1, ET-1, ROCK I levels in fasudil treatment group were significantly reduced compared with conventional therapy group(t=3.958, 4.496, 4.363, 3.875 and P < 0.01). Conclusion Fasudil can inhibit the inflammatory cytokines and improve the endothelial function, to improve curative effect of coronary slow flow.