本文選題：冠心病 + 阿托伐他汀　； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:本研究選取行PCI術(shù)的冠心病患者,探討不同劑量阿托伐他汀鈣片(Atorvastatin)對患者血清超敏C反應蛋白(hypersensitive C-reactive protein)、脂聯(lián)素(Adiponectin)、網(wǎng)膜素-1(Omentin-1)水平的影響,并觀察患者1年主要不良心血管事件(MACE)的發(fā)生情況,以便更好的為心血管疾病的預防和臨床治療提供理論依據(jù)以及能夠找到阿托伐他汀用于減輕PCI術(shù)后炎性反應的合理劑量。方法:1臨床上選取河北醫(yī)科大學附屬唐山工人醫(yī)院心內(nèi)一科2015年1月1日至2016年1月1日期間住院的行PCI術(shù)的冠心病患者111例,記錄所有患者的年齡、性別、身體質(zhì)量指數(shù)等一般臨床資料。將入院后的所有患者隨機分為40 mg高劑量A組和20 mg低劑量B組,A組56例,男性30例,女性26例,年齡48~74(58.52±11.87歲),給予口服阿托伐他汀鈣片40 mg/d。B組55例,男性27例,女性28例,年齡47~72(58.69±10.25歲),給予口服阿托伐他汀鈣片20 mg/d。2檢測并記錄患者入院前、術(shù)后3天、術(shù)后3個月的總膽固醇(TC)、甘油三酯(TG)、低密度脂蛋白膽固醇(LDL-C)、超敏C反應蛋白(hs-CRP)、APN、Omentin-1的水平,并觀察兩組患者3個月后的藥物不良反應發(fā)生情況和1年的MACE事件的發(fā)生情況。3實驗檢測方法采用酶聯(lián)免疫吸附法(ELISA)分別測定不同時間間隔兩組患者的血清hs-CRP、APN和Omentin-1的濃度,比較兩組之間的差異。4統(tǒng)計學方法:應用統(tǒng)計學軟件SPSS 21.0對收集的數(shù)據(jù)進行分析,服從正態(tài)分布的計量資料以均數(shù)±標準差(`x±s)的形式表示,不服從正態(tài)分布的資料采用中位數(shù)(四分位數(shù))表示,計量資料兩組之間的比較采用t檢驗,計數(shù)資料兩組間率的比較運用χ2檢驗,檢驗水平采用標準為P0.05認為差異有統(tǒng)計學意義。結(jié)果:1通過對兩組患者的年齡、性別比例、BMI、冠狀動脈病變情況、置入支架數(shù)量以及入院前各項血脂指標進行比較,結(jié)果為差異無統(tǒng)計學意義(均P0.05)。2 40 mg高劑量A組和20 mg低劑量B組患者入院前血清的hs-CRP、APN、Omentin-1水平相比較,差異無統(tǒng)計學意義(均P0.05)。3術(shù)后3個月40 mg高劑量A組和20 mg低劑量B組TC、TG水平均較入院前明顯降低(3.66±0.45 mmol/L)vs(4.14±0.46 mmol/L);(1.09±0.30 mmol/L)vs(1.51±0.28 mmol/L),均P0.05,差異有統(tǒng)計學意義,且40 mg高劑量A組指標明顯低于20 mg低劑量B組(P0.05)。4術(shù)后3天、術(shù)后3個月40 mg高劑量A組和20 mg低劑量B組hs-CRP水平均較入院前明顯降低(P0.05),差異有統(tǒng)計學意義。術(shù)后3天、術(shù)后3個月兩組APN、Omentin-1水平均較入院前明顯升高(P0.05),差異有統(tǒng)計學意義。且術(shù)后3個月A組hs-CRP明顯低于B組(3.12±0.85 mg/L)vs(4.36±1.22 mg/L),P0.05,差異有統(tǒng)計學意義。APN、Omentin-1水平A組明顯高于B組(14.2±2.55 mg/L)vs(8.78±3.16 mg/L);(28.9±9.59 ng/ml)vs(21.6±6.29 ng/ml),P0.05,差異有統(tǒng)計學意義。5 40 mg高劑量A組和20 mg低劑量B組患者服用阿托伐他汀后隨訪3個月時患者的藥物不良反應發(fā)生情況,A組藥物不良反應發(fā)生率為12.5%,B組藥物不良反應發(fā)生率為10.0%,P0.05,為差異無統(tǒng)計學意義。A、B組兩組1年的MACE事件發(fā)生率分別為10.7%,27.3%,兩組間比較,P0.05,差異有統(tǒng)計學意義,40 mg高劑量組MACE事件發(fā)生情況明顯低于20mg組。結(jié)論:1服用阿托伐他汀40 mg高劑量組和20 mg低劑量組相比,高劑量組患者血脂指標TC、TG水平降低更明顯,血清hs-CRP水平降低更明顯,APN、Omentin-1升高更明顯,1年內(nèi)MACE事件發(fā)生情況較低。2阿托伐他汀可以降低PCI患者血清hs-CRP的水平,提高患者血清APN和Omentin-1濃度,高劑量組能夠明顯減輕PCI術(shù)后患者的炎性反應,從而更好的保護心血管系統(tǒng)。3 40 mg阿托伐他汀是強效而安全的,對心血管系統(tǒng)具有保護作用。
[Abstract]:Objective: To investigate the effects of different doses of Atorvastatin Calcium Tablets (Atorvastatin) on serum hypersensitivity C reactive protein (hypersensitive C-reactive protein), adiponectin (Adiponectin) and omentin -1 (Omentin-1) in patients with PCI (Atorvastatin), and to observe the incidence of 1 years of major adverse cardiovascular events (MACE) in patients. In order to provide a better theoretical basis for the prevention and clinical treatment of cardiovascular diseases and to find a reasonable dose of atorvastatin for alleviating the inflammatory response after PCI. Methods: 1 clinical selection of PCI in the hospital of Tangshan workers' Hospital Affiliated to Hebei Medical University from January 1, 2015 to January 1, 2016 was selected. 111 patients with coronary heart disease were recorded in all patients' age, sex, body mass index and other general clinical data. All patients after admission were randomly divided into 40 mg high dose A group and 20 mg low dose B group, A group 56 cases, male 30 cases, female 26 cases, age 48~74 (58.52 + 11.87 years), and 55 cases of oral Atorvastatin Calcium Tablets 40 mg/d.B group, male 27. Cases, 28 women, aged 47~72 (58.69 + 10.25 years), were given an oral Atorvastatin Calcium Tablets 20 mg/d.2 test and recorded the total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), C reactive protein (hs-CRP), APN, Omentin-1 in 3 months after operation, 3 days after operation, and 3 months after two groups of patients. The occurrence of adverse drug reactions and the occurrence of MACE events in 1 years.3 experimental detection method using enzyme linked immunosorbent assay (ELISA) to determine the concentration of serum hs-CRP, APN and Omentin-1 at different time intervals, and to compare the difference between the two groups by.4 statistics method: the application statistics software SPSS 21 for the collected data into the data. In line analysis, the measurement data obeying the normal distribution are expressed in the form of mean number + standard deviation (`x + s). The data that do not obey the normal distribution are expressed in the median (four digits). The comparison between the two groups of the measured data is tested by t test. The comparison of the rate of the count data between the two groups uses the chi square 2 test, and the test level uses the standard as P0.05 that the difference is unified. Results: 1 by comparing the age, sex ratio, BMI, coronary artery disease, the number of stent placement and the blood lipid indexes before admission, the results were not statistically significant (P0.05).2 40 mg high dose A group and 20 mg low dose B group were compared with the serum hs-CRP, APN, Omentin-1 levels before admission. The difference was not statistically significant (P0.05).3 3 months 40 mg high dose A group and 20 mg low dose B group TC, the level of TG was significantly lower than before admission (3.66 + 0.45 mmol/L) vs (4.14 + 0.46 mmol/L), (1.09 + 0.30 mmol/L) (1.51 + 0.28), both of which were statistically significant, and the high dose of 40 3 days after group B (P0.05).4, 3 months after operation 40 mg high dose A group and 20 mg low dose B group, hs-CRP level was significantly lower than before admission (P0.05), the difference was statistically significant. 3 days after the operation, two groups of APN, Omentin-1 level were significantly higher than before admission (P0.05), the difference was statistically significant. And 3 months after the operation obviously lower than the group (3.12 + 0.85 mg/L) vs (4.36 + 1.22 mg/L), P0.05, the difference was statistically significant.APN, Omentin-1 level A group was significantly higher than that of B group (14.2 + 2.55 mg/L) vs (8.78 + 3.16 mg/L), (28.9 + 9.59 ng/ml) (28.9 + 9.59 ng/ml) (21.6 + 6.29). In patients with adverse drug reactions, the incidence of adverse drug reactions in group A was 12.5%, and the incidence of adverse drug reactions in group B was 10%, P0.05 was not statistically significant.A. The incidence of MACE events in two groups of two groups in group B was 10.7%, 27.3%, and two groups were compared, P0.05, the difference was statistically significant, the 40 mg high dose group MACE event happened. The situation was significantly lower than that in the 20mg group. Conclusion: 1 compared with the high dose of atorvastatin 40 mg high dose group and 20 mg low dose group, the blood lipid index of the high dose group was TC, the TG level decreased more obviously, the serum hs-CRP level decreased more obviously, the APN, Omentin-1 increased more obviously, the MACE event occurred in the 1 years, and the.2 atorvastatin could reduce the PCI patient's serum hs-C. The level of RP increases the concentration of APN and Omentin-1 in the patient's serum. The high dose group can significantly reduce the inflammatory response in the patients after PCI, thus better protection of the cardiovascular system.3 40 mg atorvastatin is strong and safe, and has protective effects on the cardiovascular system.

【學位授予單位】：河北醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4

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