本文選題：急性冠脈綜合征 + 降血脂藥　； 參考：《南京醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[背景]冠心病(coronary heart disease,CHD)尤其是急性冠狀動脈綜合征(acute coronary syndrome,ACS),隨著人口老齡化的進展,已成為導(dǎo)致人類死亡的頭號殺手。ACS發(fā)生最主要的病理生理機制為冠狀動脈粥樣硬化斑塊破裂、血管痙攣和隨之發(fā)生的血小板聚集所引起的血栓形成。而根據(jù)胸痛時的患者心電圖變化,ACS可分為非ST段抬高型ACS和ST段抬高型心肌梗死。其中前者包括有包括不穩(wěn)定型心絞痛(unstable angina,UA)和非ST段抬高型心肌梗死(Non-ST-segment elevation myocardial infarction,NSTEMI)。近些年來,隨著 ACS 介入治療技術(shù)的不斷發(fā)展和治療藥物的不斷研發(fā)生產(chǎn),使ACS患者的病死率和發(fā)病率明顯降低。伴隨著中國人民人均壽命的延長,ACS發(fā)病不僅在高齡人群中比例不斷升高,還逐漸呈現(xiàn)年輕化的趨勢。隨著冠心病患者人數(shù)的增加,慢性腎臟病在冠心病中的發(fā)生、發(fā)展得到越來越多關(guān)注,兩種疾病的關(guān)系錯綜復(fù)雜�；加新阅I臟病的患者,冠心病的發(fā)病率和死亡率明顯增加已得到共識。研究表明,輕度慢性腎功能異�；颊�,即使無冠心病危險因素,冠脈動脈疾病,左心室肥厚、慢性心力衰竭和腦卒中的發(fā)生率亦明顯增加。他汀類藥物目前已廣泛應(yīng)用于CHD患者的治療,他是一種3-羥基-3-甲基戊二酰輔酶A(HMG-Co A)還原酶抑制劑,不僅具有降血脂、抑制膽固醇合成的作用,還能抗炎、抗氧化應(yīng)激、改善機體血管內(nèi)皮的功能。有研究顯示,他汀類藥物可通過其抗氧化、抗炎癥、抗血栓、保護內(nèi)皮細(xì)胞、誘導(dǎo)血管緊張素受體下調(diào)、減少內(nèi)皮素合成等獨立于降脂之外的作用,而對腎臟有一定的保護作用。本研究擬通過比較短期強化劑量他汀類藥物治療的ACS患者與標(biāo)準(zhǔn)劑量他汀類藥物治療的ACS患者對腎功能的影響,評價強化他汀藥物治療對腎功能的安全性與療效。[目的]通過比較短期強化劑量他汀類藥物治療與標(biāo)準(zhǔn)劑量他汀類藥物治療,評價強化他汀藥物治療對腎功能的安全性與療效。[方法]病例選取2013年3月-2016年10月在杭州市第一人民醫(yī)院接受診療的急性冠脈綜合癥的患者200例,患者按單雙號隨機分成強化阿托伐他汀治療組(40mg)與常規(guī)阿托伐他汀治療組(20mg)。阿托伐他汀強化劑量治療組住院期間及出院后予以40mg/N;阿托伐他汀常規(guī)治療組住院及出院采用阿托伐他汀標(biāo)準(zhǔn)劑量(20mg/N.口服)治療。分別于服藥前及服藥后行檢測患者血脂、肝功能、高敏C反應(yīng)蛋白(hs-crp)、肌酸激酶(CK)、血肌酐水平及腎小球濾過率的指標(biāo),同時記錄兩組患者藥物引起的肝功能損傷情況。[結(jié)果](一)強化他汀組與常規(guī)他汀組ACS患者的比較:強化他汀組ACS患者男女比例為65/35,入院時測血肌酐為82.53±23.85,一個月的他汀藥物治療后血肌酐為57.81±15.27;標(biāo)準(zhǔn)劑量他汀組ACS患者男女比例為63/37,入院時測血肌酐為79.48±19.98,一月后血肌酐為63.99±15.35。兩組患者治療后的血肌酐較治療前均有所下降,差異有統(tǒng)計學(xué)意義(P0.05)。且強化組的肌酐值下降較常規(guī)組下降明顯,差異有統(tǒng)計學(xué)意義(P0.05)。(二)強化組與常規(guī)組患者腎小球濾過率的比較:強化組患者及常規(guī)組患者治療后腎小球的濾過率均較治療前有明顯改善(P0.05),其中強化組的腎小球濾過率改善較常規(guī)組改善明顯(P0.05)。(三)強化組與常規(guī)組ACS患者實驗室檢查結(jié)果的比較:強化組及常規(guī)組ACS患者總膽固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、高敏C反應(yīng)蛋白(hsCRP)的治療后較治療前均有所改善(P0.05)。而強化組患者相比較于常規(guī)組患者改善明顯(P0.05)。(四)強化組與常規(guī)組安全性的比較:治療過程中,兩組患者依從性良好,未發(fā)生明顯肌痛、肝區(qū)不適、大小便性狀及次數(shù)改變、皮膚瘙癢等不良反應(yīng)。兩組患者均有轉(zhuǎn)氨酶輕度升高者,強化組轉(zhuǎn)氨酶升高者為3人;常規(guī)組轉(zhuǎn)氨酶升高者為2人,但均未超過標(biāo)準(zhǔn)值3倍以上。[結(jié)論]相比較于標(biāo)準(zhǔn)劑量他汀組,強化他汀組患者可較好的改善患者的腎功能,且在降脂效果更強的情況下,無明顯增加不良反應(yīng)事件。
[Abstract]:[background] coronary heart disease (CHD), especially acute coronary syndrome (acute coronary syndrome, ACS), has become the most important pathophysiological mechanism of the leading killer.ACS, which leads to human death, with the progress of population aging. It is the rupture of atherosclerotic plaque, blood vessel spasm, and the consequent blood. ACS can be divided into non ST segment elevation ACS and ST segment elevation myocardial infarction, which includes unstable angina (unstable angina, UA) and non ST segment elevation myocardial infarction (Non-ST-segment elevation myocardial infarction), according to the changes in ECG in patients with chest pain. In recent years, with the continuous development of ACS interventional therapy and the continuous development and production of therapeutic drugs, the mortality and morbidity of ACS patients are obviously reduced. With the prolongation of the life expectancy of the Chinese people, the incidence of ACS is not only increasing in the elderly population, but also gradually becoming younger. With the number of patients with coronary heart disease, the number of patients with coronary heart disease is gradually increased. More and more attention has been paid to the development of chronic kidney disease in coronary heart disease. The relationship between the two diseases is complicated. The incidence and mortality of coronary heart disease in patients with chronic renal disease have been significantly increased. The incidence of disease, left ventricular hypertrophy, chronic heart failure and stroke also increased significantly. Statins are now widely used in the treatment of CHD patients. He is a 3- hydroxyl -3- methylglutaminic coenzyme A (HMG-Co A) reductase inhibitor, which not only has the effect of lowering blood lipids, inhibiting the synthesis of cholesterol, but also anti-inflammatory, antioxidant stress, and modification. Studies have shown that statins can protect the kidneys by their antioxidation, anti-inflammatory, antithrombotic, protective endothelial cells, induction of angiotensin receptor downregulation, and reduction of endothelin synthesis, and to a certain protective effect on the kidneys. This study is to be compared to short-term intensive dose statins. The effect of ACS patients treated with ACS and standard dose statins on renal function, evaluation of the safety and efficacy of statin therapy on renal function. [Objective] to evaluate statin therapy for renal function by comparing short-term intensive dose statins and standard dose statins. [Methods] 200 cases of acute coronary syndrome in No.1 People's Hospital of Hangzhou in October -2016 March 2013 were selected. The patients were randomly divided into intensive atorvastatin treatment group (40mg) and conventional atorvastatin treatment group (20mg). The hospitalization period of the intensive dose treatment group of atorvastatin. 40mg/N; atrovastatin routine treatment group was hospitalized and discharged with the standard dose of atorvastatin (20mg/N. oral). The blood lipid, liver function, high sensitive C reactive protein (hs-CRP), creatine kinase (CK), serum creatinine level and glomerular filtration rate were measured before and after medication, and two groups were recorded at the same time. [results] [results] (1) the comparison between the intensive statins group and the routine statin group ACS patients: the ratio of men and women with ACS in the statins group was 65/35, the serum creatinine was 82.53 + 23.85 at admission, the serum creatinine was 57.81 + after one month statin therapy, and the ratio of ACS in the standard dose statin group was 63/37, The serum creatinine was 79.48 + 19.98 at admission and the serum creatinine was decreased in 63.99 + 15.35. two groups after one month. The difference was statistically significant (P0.05). The decrease of creatinine in the intensifying group was significantly lower than that in the conventional group (P0.05). (two) glomerular filtration in the intensive and conventional groups Rate comparison: the glomerular filtration rate of the patients in the intensive group and the routine group were significantly improved after the treatment (P0.05). The glomerular filtration rate in the strengthening group was improved significantly compared with the conventional group (P0.05). (three) the comparison of the laboratory results between the intensive group and the routine group of ACS patients: the total cholesterol (TC) in the intensive and conventional group ACS patients (TC ) triglyceride (TG), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), and Gao Min C reactive protein (hsCRP) were improved after treatment (P0.05). Compared with the conventional group, the patients in the strengthening group were significantly improved (P0.05). (four) compared with the routine group, the two groups were well compliant in the treatment process. No obvious myalgia, discomfort in the liver, changes in the size and number of stool, changes in the number of times, and skin pruritus, and other adverse reactions. The two groups had slightly elevated aminotransferase, 3 in the enhanced group of aminotransferase, 2 in the routine group of transaminase, but not more than 3 times the standard value. [Conclusion] compared to the standard dose statins group, the statins group was strengthened. Patients can improve the renal function of patients better, and there is no obvious increase in adverse reactions when the effect of lipid-lowering is stronger.

【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4

【參考文獻】

相關(guān)期刊論文 前8條

1 紀(jì)芳杰;叢洪良;楊世誠;付乃寬;;強化阿托伐他汀治療對高血壓合并慢性腎功能不全患者經(jīng)皮冠狀動脈介入治療后對比劑腎病的預(yù)防作用[J];中華高血壓雜志;2013年06期

2 孫維娜;王蓓蓓;;阿妥伐他汀多效性作用臨床應(yīng)用進展[J];中華全科醫(yī)學(xué);2011年01期

3 高瀾;楊俊娟;李建平;霍勇;;對接受介入治療的急性冠狀動脈綜合征患者的慢性腎臟病調(diào)查[J];中國介入心臟病學(xué)雜志;2010年03期

4 苗冬梅;曹瑞華;劉源;張今堯;;老年人慢性腎功能不全對冠心病預(yù)后的影響[J];中華老年多器官疾病雜志;2010年02期

5 穆樹林;張柳;梁春雨;;他汀類藥物對骨質(zhì)疏松癥的影響研究進展[J];中國骨質(zhì)疏松雜志;2008年08期

6 張麗;陳曦;;血清高敏C反應(yīng)蛋白與心血管病關(guān)系的研究進展[J];國際檢驗醫(yī)學(xué)雜志;2006年05期

7 陳光鈴;蘇津自;;阿托伐他汀改善對比劑對腎功能的短期影響[J];中華心血管病雜志;2009年05期

8 周霞;金元哲;王琦;閔睿;張學(xué)穎;;大劑量阿托伐他汀預(yù)防對比劑腎病[J];中華心血管病雜志;2009年05期

，

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