本文關(guān)鍵詞： 依折麥布 非ST段抬高型心肌梗死 血脂 炎癥因子 短期預(yù)后　出處：《昆明醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：[目的]通過本研究,研討依折麥布對(duì)非ST段抬高型心肌梗死(NSTEMI)患者血脂水平、炎癥因子及短期預(yù)后的影響,以便為臨床治療方案提供參考。[方法]收集2016年1月至2016年9月于我院住院治療患者的臨床資料,根據(jù)制定的納入及排除標(biāo)準(zhǔn)再次篩選符合條件的病人,共計(jì)70例,將70例NSTEMI患者入院后立即隨機(jī)分為依折麥布(益適純,10mg/qd)聯(lián)合阿托伐他汀(立普妥,20mg/qn)治療組,即實(shí)驗(yàn)組,共32例;單用阿托伐他汀治療組(20mg/qn),即對(duì)照組,共38例。統(tǒng)計(jì)所有入組病人的性別、年齡、高血壓史、糖尿病史、吸煙史,治療前高敏C反應(yīng)蛋白(hs-CRP)、白介素-6(IL-6)、降鈣素原(PCT)、總膽固醇(TC)、低密度脂蛋白(LDL-C)、甘油三酯(TG)、腦利鈉肽(BNP)、左室舒張末期內(nèi)徑(LVEDD)、左室收縮末內(nèi)徑(LVESD)、左室射血分?jǐn)?shù)(LVEF)。所有入組患者于出院后隨訪,隨訪時(shí)間為6個(gè)月;隨訪內(nèi)容包括hs-CRP、IL-6、PCT、LDL-C、TG、TC、BNP、LVEDD、LVESD、LVEF,治療期間藥物不良反應(yīng),治療6個(gè)月后主要心臟不良事件(MACE,心源性死亡、再次心肌梗死、再發(fā)心絞痛、繼發(fā)心衰和腦卒中)發(fā)生率等相關(guān)數(shù)據(jù)。采用SPSS19.0統(tǒng)計(jì)包分析數(shù)據(jù)資料,以P0.05判斷為差異有統(tǒng)計(jì)學(xué)意義。[結(jié)果]兩組患者間在人口統(tǒng)計(jì)特征及基本臨床資料上無明顯差異;(1)治療前實(shí)驗(yàn)組及對(duì)照組患者TC、LDL-C及TG基線水平差異無統(tǒng)計(jì)學(xué)意義(P0.05):治療6個(gè)月后隨訪:兩組患者LDL-C及TC水平均降低,且實(shí)驗(yàn)組較治療組LDL-C、TC水平降低更加明顯,兩組間比較差異有統(tǒng)計(jì)學(xué)意義(分別為P0.05和P0.01),治療后實(shí)驗(yàn)組血脂達(dá)標(biāo)率較對(duì)照組更高,兩組間比較差異有統(tǒng)計(jì)學(xué)意義(P0.01);而治療后實(shí)驗(yàn)組及對(duì)照組患者甘油三脂(TG)無明顯降低,兩組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(2)治療前實(shí)驗(yàn)組及對(duì)照組患者BNP、hs-CRP、IL-6及PCT差異無統(tǒng)計(jì)學(xué)意義(P0.05);治療6個(gè)月后兩組患者BNP、hs-CRP、IL-6及PCT均降低,與對(duì)照組相比,實(shí)驗(yàn)組患者h(yuǎn)s-CRP、IL-6、PCT降低更加明顯,兩組間比較差異有統(tǒng)計(jì)學(xué)意義(分別為P0.05,P0.01和P0.01),而治療后BNP兩組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(3)實(shí)驗(yàn)組及對(duì)照組無肝酶升高、CK升高、肌酐升高、肌痛、過敏反應(yīng)等不良反應(yīng)退出實(shí)驗(yàn)。(4)實(shí)驗(yàn)組及對(duì)照組治療6個(gè)月后MACE的發(fā)生率比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(5)治療前實(shí)驗(yàn)組及對(duì)照組患者LVEDD、LVESD、LVEF差異無統(tǒng)計(jì)學(xué)意義(P0.05);治療6個(gè)月后兩組患者的LVEDD、LVESD、LVEF均無明顯改善,且兩組間比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。[結(jié)論]阿托伐他汀可以有效降低患者TC、LDL-C、BNP、hs-CRP、IL-6及PCT水平;在阿托伐他汀的基礎(chǔ)上聯(lián)合依折麥布可進(jìn)一步降低TC、LDL-C,hs-CRP、IL-6及PCT水平,提高血脂的達(dá)標(biāo)率;聯(lián)合用藥對(duì)NSTEMI患者的短期預(yù)后尚無明顯改善。
[Abstract]:[objective] to study the effects of Ezeimib on blood lipid levels, inflammatory factors and short-term prognosis in patients with non-ST-segment elevation myocardial infarction (NSTEMI). In order to provide reference for clinical treatment scheme. [methods] the clinical data of inpatients in our hospital from January 2016 to September 2016 were collected. According to the criteria of inclusion and exclusion, 70 eligible patients were re-screened. Immediately after admission, 70 patients with NSTEMI were randomly divided into two groups: the treatment group of Ezeimet (10 mg / QD) and the treatment group of 20 mg / QN of Lipitor, the experimental group (32 cases), and the group treated with Atto vastatin (20 mg / qng), that is, the control group. Gender, age, history of hypertension, history of diabetes, history of smoking, Before treatment, Gao Min C-reactive protein hs-CRPU, interleukin-6 siloxacin IL-6, procalcitonin protopril, total cholesterol TCU, low density lipoprotein (LDL-C), triglyceride (TGN), brain natriuretic peptide (BNPN), left ventricular end-diastolic diameter (LVEDDD), left ventricular end-systolic dimension (LVESDD), left ventricular ejection fraction (LVEF), and left ventricular ejection fraction (LVEF). The patients were followed up after discharge. The follow-up period was 6 months. The follow-up included hs-CRP IL-6, PCT, LDL-Con, TGN, TGN, LVEDDD, LVESD-LVEF, adverse drug reactions during the treatment period, major adverse cardiac events such as MACEE, cardiogenic death, secondary myocardial infarction and recurrent angina pectoris after 6 months of treatment. SPSS19.0 statistical package was used to analyze the data. [results] there was no significant difference in the demographic characteristics and basic clinical data between the two groups. [results] there was no significant difference in the baseline level of TCU LDL-C and TG between the experimental group and the control group before treatment. P0.05: follow up after 6 months: the levels of LDL-C and TC decreased in both groups. The LDL-CU TC level in the experimental group was significantly lower than that in the treatment group, and the difference between the two groups was statistically significant (P0.05 and P0.01, respectively). After treatment, the blood lipids reached the standard rate in the experimental group was higher than that in the control group. The difference between the two groups was statistically significant (P 0.01), but there was no significant decrease in triglyceride TG after treatment in the experimental group and the control group. There was no significant difference in BNPhs-CRPnIL-6 and PCT between the two groups before and after treatment, but after 6 months of treatment, the levels of BNPhs-CRPU IL-6 and PCT in the two groups were lower than those in the control group, and the hs-CRPIL-6PCT in the experimental group was significantly lower than that in the control group. There were significant differences between the two groups (P0.05, P0.01 and P0.01, respectively, but there was no significant difference between the two groups after treatment.) there was no increase in CK, creatinine and myalgia in the experimental group and the control group. After 6 months of treatment, there was no significant difference in the incidence of MACE between the experimental group and the control group. (P0.05) before treatment, there was no significant difference in LVEDDD, LVESDSD, LVEF in the experimental group and control group, and in the 6 months of treatment, there was no significant difference in the incidence of MACE in the experimental group and the control group, and in the treatment of 6 months, there was no significant difference in the incidence of MACE. There was no significant improvement in LVEF of LVEDDV LVESDN in the latter two groups. There was no significant difference between the two groups (P 0.05). [conclusion] Atto vastatin can effectively reduce the levels of IL-6 and PCT in patients with TCU LDL-CnBNPHs-CRPU, and combine with Ezeimebumin on the basis of Atto statin can further decrease the levels of TCL-Chs-CRPIL-6 and PCT, and increase the blood lipid compliance rate. The short-term prognosis of patients with NSTEMI was not significantly improved by combined use of drugs.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R542.22

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