本文選題：雷公藤多苷 + 冠心病�。� 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:探討雷公藤多苷對冠心病PCI患者術(shù)后冠脈支架內(nèi)再狹窄發(fā)生率和遠(yuǎn)期預(yù)后的影響。方法:將2015年06月到2015年12月期間在青島大學(xué)醫(yī)學(xué)院附屬醫(yī)院及高密市人民醫(yī)院心內(nèi)科住院接受經(jīng)皮冠狀動脈介入治療(percutaneous coronary intervention,PCI)的患者隨機入組。其中對照組79例,年齡30-89歲,其中男性56例,女性23例。行PCI治療后常規(guī)給予阿司匹林+氫氯吡格雷雙聯(lián)抗血小板、他汀類調(diào)脂、穩(wěn)定斑塊、控制血糖、血壓等治療。觀察組79例,年齡30-89歲,其中男性61例,女性18例。在對照組治療方案基礎(chǔ)上于術(shù)后24小時內(nèi)加用雷公藤多苷片按1mg/(kg·d),每天分三次服用2個月,在每次口服劑量不變情況下改為每天兩次服用2個月,最后改為每天一次服用2個月。兩組患者每月一次復(fù)查,統(tǒng)計所有病例的一般資料,包括甘油三酯(TG),低密度脂蛋白(LDL),總膽固醇(Tcho),糖化血紅蛋白(HBa1c),射血分?jǐn)?shù)(EF),收縮壓(Sbp),舒張壓(Dbp),脈搏(p),血常規(guī)及肝腎功,隨訪1年,了解患者主要心臟不良事件(major adverse cardiac events,MACE)情況(死亡、非致死性心肌梗死和靶血管血運重建)。應(yīng)用COX多因素分析比較觀察組和對照組在校正了其他變量時MACE發(fā)生率差異是否存在統(tǒng)計學(xué)意義。結(jié)果:觀察組患者在服用雷公藤多苷片2個月后有6例出現(xiàn)胃腸道不適癥狀,有3例患者出現(xiàn)白細(xì)胞下降,有9例出現(xiàn)谷丙轉(zhuǎn)氨酶(ALT)升高,在藥物減量及停藥后即好轉(zhuǎn)。分析結(jié)果顯示,兩組患者在年齡、性別構(gòu)成、心率、血壓、左室射血分?jǐn)?shù)、病變部位、病變類型等方面差異無統(tǒng)計學(xué)意義(P0.05)。在前4個月的時間里在總膽固醇、低密度脂蛋白、谷丙轉(zhuǎn)氨酶等方面表現(xiàn)出了統(tǒng)計學(xué)差異(P0.05),而這種差異在1年后消失,在一年后的隨訪中,在所有入組的158名患者當(dāng)中,發(fā)生MACE事件的有15例,MACE事件的發(fā)生率為9.80%,其中觀察組有3例,對照組有12例,總膽固醇、低密度脂蛋白、谷丙轉(zhuǎn)氨酶差異具有統(tǒng)計學(xué)意義(P0.05)。觀察組MACE發(fā)生率3.7%(3例),其中死亡1例,血運重建2例;對照組MACE發(fā)生率10.1%(12例),其中血運重建9例;非致死性心肌梗死3例。兩組患者在1年后MACE事件發(fā)生率有統(tǒng)計學(xué)差異(P0.05),將所有患者基線資料進(jìn)行COX單因素分析顯示,低密度脂蛋白、總膽固醇、收縮壓對MACE事件發(fā)生率的影響具有統(tǒng)計學(xué)意義,將分組、低密度脂蛋白、總膽固醇、收縮壓納入COX多因素分析顯示,在校正了其他變量后,觀察組和對照組患者M(jìn)ACE發(fā)生率差具有統(tǒng)計學(xué)意義(P=0.0413,HR=0.808,CI95%=0.259-2.517)。結(jié)論:1.應(yīng)用雷公藤多苷會在短期內(nèi)降低患者的白細(xì)胞,升高患者的谷丙轉(zhuǎn)氨酶,停藥后會逐漸消退。2.雷公藤多苷顯示出可以減少PCI患者術(shù)后MACE事件的發(fā)生率。3.雷公藤多苷顯示出具有降低PCI術(shù)后冠脈支架再狹窄的發(fā)生率的趨勢,但差異不具有統(tǒng)計學(xué)意義(P0.05)。
[Abstract]:Objective: to investigate the effect of tripterygium wilfordii polyglycosides on the incidence and long-term prognosis of coronary stent restenosis in patients with coronary heart disease (PCI). Methods: from June 2015 to December 2015, patients who were hospitalized in Department of Cardiology, affiliated Hospital of Medical College of Qingdao University and Department of Cardiology, Gaomi City people's Hospital, received percutaneous coronary intervention therapy (coronary interventionn). There were 79 cases in the control group, aged 30-89 years, including 56 males and 23 females. After PCI treatment, aspirin hydroclopidogrel dual antiplatelet therapy, statin lipid regulation, plaque stabilization, blood glucose control, blood pressure, and so on. There were 79 cases in the observation group, aged 30-89 years, including 61 males and 18 females. On the basis of the treatment plan of the control group, tripterygium wilfordii polyglycoside tablet was added within 24 hours after operation according to 1mg/(kg dai, divided into 3 times a day for 2 months, then taken twice a day for 2 months at the same oral dose per day, and then changed to once a day for 2 months at last. The patients in the two groups were reviewed once a month. The general data of all patients were analyzed, including triglyceride, low density lipoprotein (LDLN), total cholesterol, HBa1cn, ejection fraction (EFF), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse, blood routine, and liver and kidney function. The patients were followed up for 1 year to find out the major adverse cardiac events (death, non-fatal myocardial infarction and target vessel revascularization). COX multivariate analysis was used to compare whether there was significant difference in the incidence of MACE between the observation group and the control group when the other variables were adjusted. Results: after taking tripterygium wilfordii polyglycosides for 2 months, there were 6 cases of gastrointestinal discomfort, 3 cases of leukopenia and 9 cases of elevated alanine aminotransferase (alt). The results showed that there were no significant differences in age, sex composition, heart rate, blood pressure, left ventricular ejection fraction (LVEF), lesion location and pathological type between the two groups (P 0.05). During the first four months, there was a statistically significant difference in total cholesterol, low density lipoprotein, alanine aminotransferase, and so on, which disappeared after one year and was followed up one year later among all 158 patients who entered the group. The incidence of Mace in 15 patients with MACE was 9.80. There were 3 cases in the observation group and 12 cases in the control group. There were significant differences in total cholesterol, low density lipoprotein and alanine aminotransferase between the two groups (P 0.05). The incidence of MACE in the observation group was 3.7%, including death in 1 case and revascularization in 2 cases, in the control group, the incidence of MACE was 10.1 in 12 cases, including 9 cases of revascularization, and 3 cases of non-fatal myocardial infarction. There was a significant difference in the incidence of MACE events between the two groups after one year. The baseline data of all patients were analyzed by COX univariate analysis. The effects of low density lipoprotein (LDL), total cholesterol (TC) and systolic blood pressure (SBP) on the incidence of MACE events were statistically significant. COX multivariate analysis showed that after adjusting for other variables, the incidence of MACE in the observation group and the control group was significantly lower than that in the control group. There was a significant difference in the incidence of MACE between the observation group and the control group. The incidence of MACE was 0.808% CI 9595 and 0.259-2.517% after adjusting for the other variables in the group of low density lipoprotein (LDL), total cholesterol and systolic blood pressure (SBP). Conclusion 1. Tripterygium wilfordii polyglycosides can reduce the leukocyte in patients in a short period of time, increase the alanine aminotransferase in patients, and gradually fade. 2. Tripterygium wilfordii polyglycosides have been shown to reduce the incidence of MACE events in patients with PCI. Tripterygium wilfordii showed a tendency to reduce the incidence of coronary stent restenosis after PCI, but the difference was not statistically significant (P 0.05).
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.4

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