瑞舒伐他汀強化治療對行PCI的ACS患者Lp-PLA2和Hs-CRP水平的影響
發(fā)布時間：2018-08-03 10:04
【摘要】：目的:探討阿托伐他汀和不同劑量瑞舒伐他汀治療對行經(jīng)皮冠狀動脈介入治療(percutaneous coronary intervention,PCI)的急性冠脈綜合征(acute coronary syndrome,ACS)患者圍手術期血漿脂蛋白相關磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)和血清超敏C反應蛋白(high-sensitivity C-reactive protein,Hs-CRP)水平的影響,觀察Lp-PLA2和Hs-CRP水平與ACS患者冠狀動脈病變的關系。方法:1入選2016年1月至2016年10月在滄州市中心醫(yī)院心血管內(nèi)五科住院治療,行冠狀動脈造影術(coronary angiography,CAG)且PCI的ACS患者90例,其被隨機分為三組:1)瑞舒伐他汀常規(guī)劑量(10mg)組(n=29):患者入院后常規(guī)給予瑞舒伐他汀10mg每晚口服;2)阿托伐他汀常規(guī)劑量(20mg)組(n=31):患者入院后常規(guī)給予阿托伐他汀20mg每晚口服;3)瑞舒伐他汀強化劑量(20mg)組(n=30):患者入院后常規(guī)給予瑞舒伐他汀10mg每晚口服,術前一天至術后三天給予20mg每晚口服,此后改為10mg每晚口服。所有入選的ACS患者入院后詳細記錄一般臨床資料,包括年齡(age)、性別(gender)、身高(height)、體重(weight)、體重指數(shù)(body mass index,BMI)、收縮壓(systolic blood pressure,SBP)、心率(heart rate,HR)、吸煙史(smoking history)、高血壓病史(hypertension history)、血糖(glucose,GLU)、糖尿病病史(diabetes history)、總膽固醇(total cholesterol,TC)、高密度脂蛋白膽固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白膽固醇(low-density lipoprotein cholesterol,LDL-C)、甘油三酯(triglyceride,TG)、ACS類型等,比較各組間基線資料參數(shù)差異。2根據(jù)入選的ACS患者冠狀動脈造影檢查結果,明確冠狀動脈病變情況(病變血管支數(shù)、部位以及狹窄程度),利用Gensini積分量化冠狀動脈病變程度,并分析血漿脂蛋白相關磷脂酶A2水平、血清超敏C反應蛋白水平與冠狀動脈病變程度的相關性。3所有入選的ACS患者分別于術前1天及PCI術后24小時、72小時抽取血樣,用于測定血漿Lp-PLA2、血清Hs-CRP等指標水平,比較各組間水平差異。4采用SPSS19.0統(tǒng)計學軟件對試驗數(shù)據(jù)進行統(tǒng)計學分析。服從正態(tài)分布的計量資料以“均數(shù)±標準差”表示,多組間數(shù)據(jù)比較采用單因素方差分析,P0.05時采用LSD-t檢驗進行兩兩比較;不服從正態(tài)分布的計量資料以中位數(shù)(四分位數(shù)間距)表示,多組間數(shù)據(jù)比較采用非參數(shù)Kruskal-Wallis H檢驗。計數(shù)資料以百分比表示,比較采用卡方檢驗。相關分析中,兩變量不均服從正態(tài)分布,采用Spearman秩相關分析。以檢驗水準P0.05具有統(tǒng)計學差異。結果:1三組ACS患者臨床基本資料包括年齡、性別、體重指數(shù)、收縮壓、心率、吸煙史、高血壓病史、血糖、糖尿病病史、總膽固醇、甘油三酯、高密度脂蛋白膽固醇、低密度脂蛋白膽固醇、ACS類型等均無統(tǒng)計學差異(P0.05);2三組ACS患者PCI術前,術后24小時、72小時,組間和組內(nèi)Hs-CRP水平比較,均無統(tǒng)計學差異(P0.05);3三組ACS患者Lp-PLA2水平比較3.1三組ACS患者組間Lp-PLA2水平比較PCI術前,三組Lp-PLA2水平比較無統(tǒng)計學差異(P0.05);PCI術后24小時,三組Lp-PLA2水平比較無統(tǒng)計學差異(P0.05);PCI術后72小時,瑞舒伐他汀常規(guī)劑量組與阿托伐他汀常規(guī)劑量組Lp-PLA2水平比較,無統(tǒng)計學差異(P0.05);瑞舒伐他汀強化劑量組與瑞舒伐他汀常規(guī)劑量組Lp-PLA2水平比較降低,具有統(tǒng)計學差異(P0.05),瑞舒伐他汀強化劑量組與阿托伐他汀常規(guī)劑量組Lp-PLA2水平比較降低,具有統(tǒng)計學差異(P0.05);3.2三組ACS患者組內(nèi)Lp-PLA2水平比較三組ACS患者PCI術后24小時Lp-PLA2水平較術前均升高,具有統(tǒng)計學差異(P0.05);瑞舒伐他汀常規(guī)劑量組、阿托伐他汀常規(guī)劑量組PCI術后72小時Lp-PLA2水平較術前升高,具有統(tǒng)計學差異(P0.05),瑞舒伐他汀強化劑量組PCI術后72小時Lp-PLA2水平與術前比較,無統(tǒng)計學差異(P0.05);PCI術后72小時,瑞舒伐他汀常規(guī)劑量組、阿托伐他汀常規(guī)劑量組PCI術后72小時Lp-PLA2水平較術后24小時降低,無統(tǒng)計學差異(P0.05),瑞舒伐他汀強化劑量組PCI術后72小時Lp-PLA2水平較術后24小時降低,具有統(tǒng)計學差異(P0.05);4血漿Lp-PLA2水平與ACS患者冠狀動脈病變Gensini積分呈正相關(r=0.355,P=0.001);5 Hs-CRP水平與ACS患者冠狀動脈病變Gensini積分零相關(P0.05)。結論:1血漿Lp-PLA2水平較血清Hs-CRP水平更能反映PCI對ACS患者血管造成的損傷、引起的炎癥反應以及斑塊穩(wěn)定性的變化情況。2強化劑量瑞舒伐他汀治療較常規(guī)劑量瑞舒伐他汀和常規(guī)劑量阿托伐他汀治療,有更好的抗炎作用。3血漿Lp-PLA2水平與ACS患者冠狀動脈病變呈正相關。
[Abstract]:Objective: To explore the perioperative plasma lipoprotein related phospholipase A2 (lipoprotein-associated phospholipase A2,) and blood in patients with acute coronary syndrome (acute coronary syndrome, ACS) treated with atorvastatin and different doses of rosuvastatin in patients with percutaneous coronary intervention (PCI) (acute coronary syndrome, ACS). The relationship between the level of high-sensitivity C-reactive protein (Hs-CRP) and the level of the hypersensitive C reaction protein (Hs-CRP) was observed. Methods: 1 the patients were admitted to the Cangzhou Central Hospital from January 2016 to October 2016, and were hospitalized in the five families of the Cangzhou Central Hospital, and performed coronary angiography (coronary angiography, CAG) and P. 90 patients with ACS of CI were randomly divided into three groups: 1) routine dose of rosuvastatin (10mg) group (n=29): the patients were given routine administration of rosuvastatin 10mg every night after admission; 2) the Atorvastatin routine dose (20mg) group (n=31): the patients were given atorvastatin every night after admission; 3) the intensive dose of rosuvastatin (20mg) group (n=30): The patients were given a routine oral administration of rosuvastatin 10mg every night after admission and were given 20mg every night before the operation, three days after the operation, and then changed to 10mg every night. All the selected ACS patients were enrolled in the general clinical data, including age (age), sex (gender), height (height), weight (weight), body mass index (body mass index, BMI), Systolic blood pressure (systolic blood pressure, SBP), heart rate (heart rate, HR), smoking history (smoking history), hypertension history (hypertension history), blood sugar, diabetes history, total cholesterol, high-density lipoprotein cholesterol, low density fat Low-density lipoprotein cholesterol (LDL-C), triglyceride (triglyceride, TG), ACS type, and so on. Compare the difference of baseline data between each group.2 based on the results of coronary angiography of the selected ACS patients, the coronary artery disease (the number of vessel, the position and the degree of stenosis) was determined by the Gensini integral quantification. The degree of coronary artery disease, and the correlation of plasma lipoprotein related phospholipase A2 level, serum hypersensitivity C reaction protein level and coronary artery disease degree, all selected ACS patients were selected 1 days before and 24 hours after PCI, 72 hours of blood samples, used for measuring plasma Lp-PLA2, serum Hs-CRP and other indicators, compared with each group. The level difference.4 was statistically analyzed by the SPSS19.0 statistical software. The measurement data obeying the normal distribution were expressed as "mean number + standard deviation". The data of multiple groups were compared by single factor analysis of variance, and the LSD-t test was used for 22 comparison in P0.05; the median (four dislocations) that did not obey the normal distribution was in the median. Number spacing) indicated that non parametric Kruskal-Wallis H test was used for data comparison between multiple groups. Counting data was expressed as percentage and chi square test was compared. In correlation analysis, two variables were not all subject to normal distribution and Spearman rank correlation analysis was used to test the level of P0.05 with statistical differences. Results: 1 and three groups of ACS patients' basic clinical data package Age, sex, body mass index, systolic pressure, heart rate, smoking history, hypertension history, blood sugar, diabetes history, total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, ACS type, and so on were not statistically different (P0.05); 2 the three groups of ACS patients were 24 hours, 72 hours after the operation, and the Hs-CRP level in the group and group was compared. There was no statistical difference (P0.05); 3 the level of Lp-PLA2 in three groups of ACS patients was compared with the Lp-PLA2 level of ACS patients in group 3.1. There was no statistical difference between the three groups before PCI (P0.05); 24 hours after PCI, three groups of Lp-PLA2 levels were not statistically different (P0.05); and 72 hours after PCI, the routine dose group of rosuvastatin and Alto The level of Lp-PLA2 in the routine dose group of lovastatin was not statistically significant (P0.05), and the level of Lp-PLA2 in the intensive dose group of rosuvastatin and the routine dose group of rosuvastatin was lower than that of the routine dose group (P0.05). The level of Lp-PLA2 in the intensive dose group of rosuvastatin and the regular dose group of atorvastatin was lower than that of the Atorvastatin group, and there was a statistically significant difference. The level of Lp-PLA2 in 3.2 groups of ACS patients was compared with that of three groups of ACS patients, 24 hours after PCI, the Lp-PLA2 level was higher than that before the operation, with statistical difference (P0.05); the routine dose group of rosuvastatin was higher than that of the routine dose group of atorvastatin 72 hours after PCI operation, and there was a statistically significant difference (P0.05) and strong statins (P0.05). There was no statistical difference (P0.05) at 72 hours after operation at 72 hours after operation in the dose group. 72 hours after PCI, the routine dose group of rosuvastatin, 72 hours after PCI operation in the routine dose group of atorvastatin lower than 24 hours after the operation, there was no statistical difference (P0.05), and 72 hours after PCI operation in the intensive dose group of rosuvastatin was 72 hours Lp-PLA2. The level was lower than 24 hours after the operation (P0.05), and the level of plasma Lp-PLA2 was positively correlated with the Gensini score of coronary artery disease in ACS patients (r=0.355, P=0.001), and the level of 5 Hs-CRP was zero correlation with the Gensini integral of coronary artery disease in ACS patients (P0.05). Conclusion: 1 the Lp-PLA2 level of plasma is better than the level of serum Hs-CRP. Changes in blood vessel damage, inflammatory response and plaque stability.2 enhanced dose of rosuvastatin treatment compared with conventional dose rosuvastatin and routine dose atorvastatin treatment, the better anti inflammatory effect of.3 plasma Lp-PLA2 level was positively correlated with coronary artery disease in ACS patients.
【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
本文編號：2161400
[Abstract]:Objective: To explore the perioperative plasma lipoprotein related phospholipase A2 (lipoprotein-associated phospholipase A2,) and blood in patients with acute coronary syndrome (acute coronary syndrome, ACS) treated with atorvastatin and different doses of rosuvastatin in patients with percutaneous coronary intervention (PCI) (acute coronary syndrome, ACS). The relationship between the level of high-sensitivity C-reactive protein (Hs-CRP) and the level of the hypersensitive C reaction protein (Hs-CRP) was observed. Methods: 1 the patients were admitted to the Cangzhou Central Hospital from January 2016 to October 2016, and were hospitalized in the five families of the Cangzhou Central Hospital, and performed coronary angiography (coronary angiography, CAG) and P. 90 patients with ACS of CI were randomly divided into three groups: 1) routine dose of rosuvastatin (10mg) group (n=29): the patients were given routine administration of rosuvastatin 10mg every night after admission; 2) the Atorvastatin routine dose (20mg) group (n=31): the patients were given atorvastatin every night after admission; 3) the intensive dose of rosuvastatin (20mg) group (n=30): The patients were given a routine oral administration of rosuvastatin 10mg every night after admission and were given 20mg every night before the operation, three days after the operation, and then changed to 10mg every night. All the selected ACS patients were enrolled in the general clinical data, including age (age), sex (gender), height (height), weight (weight), body mass index (body mass index, BMI), Systolic blood pressure (systolic blood pressure, SBP), heart rate (heart rate, HR), smoking history (smoking history), hypertension history (hypertension history), blood sugar, diabetes history, total cholesterol, high-density lipoprotein cholesterol, low density fat Low-density lipoprotein cholesterol (LDL-C), triglyceride (triglyceride, TG), ACS type, and so on. Compare the difference of baseline data between each group.2 based on the results of coronary angiography of the selected ACS patients, the coronary artery disease (the number of vessel, the position and the degree of stenosis) was determined by the Gensini integral quantification. The degree of coronary artery disease, and the correlation of plasma lipoprotein related phospholipase A2 level, serum hypersensitivity C reaction protein level and coronary artery disease degree, all selected ACS patients were selected 1 days before and 24 hours after PCI, 72 hours of blood samples, used for measuring plasma Lp-PLA2, serum Hs-CRP and other indicators, compared with each group. The level difference.4 was statistically analyzed by the SPSS19.0 statistical software. The measurement data obeying the normal distribution were expressed as "mean number + standard deviation". The data of multiple groups were compared by single factor analysis of variance, and the LSD-t test was used for 22 comparison in P0.05; the median (four dislocations) that did not obey the normal distribution was in the median. Number spacing) indicated that non parametric Kruskal-Wallis H test was used for data comparison between multiple groups. Counting data was expressed as percentage and chi square test was compared. In correlation analysis, two variables were not all subject to normal distribution and Spearman rank correlation analysis was used to test the level of P0.05 with statistical differences. Results: 1 and three groups of ACS patients' basic clinical data package Age, sex, body mass index, systolic pressure, heart rate, smoking history, hypertension history, blood sugar, diabetes history, total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, ACS type, and so on were not statistically different (P0.05); 2 the three groups of ACS patients were 24 hours, 72 hours after the operation, and the Hs-CRP level in the group and group was compared. There was no statistical difference (P0.05); 3 the level of Lp-PLA2 in three groups of ACS patients was compared with the Lp-PLA2 level of ACS patients in group 3.1. There was no statistical difference between the three groups before PCI (P0.05); 24 hours after PCI, three groups of Lp-PLA2 levels were not statistically different (P0.05); and 72 hours after PCI, the routine dose group of rosuvastatin and Alto The level of Lp-PLA2 in the routine dose group of lovastatin was not statistically significant (P0.05), and the level of Lp-PLA2 in the intensive dose group of rosuvastatin and the routine dose group of rosuvastatin was lower than that of the routine dose group (P0.05). The level of Lp-PLA2 in the intensive dose group of rosuvastatin and the regular dose group of atorvastatin was lower than that of the Atorvastatin group, and there was a statistically significant difference. The level of Lp-PLA2 in 3.2 groups of ACS patients was compared with that of three groups of ACS patients, 24 hours after PCI, the Lp-PLA2 level was higher than that before the operation, with statistical difference (P0.05); the routine dose group of rosuvastatin was higher than that of the routine dose group of atorvastatin 72 hours after PCI operation, and there was a statistically significant difference (P0.05) and strong statins (P0.05). There was no statistical difference (P0.05) at 72 hours after operation at 72 hours after operation in the dose group. 72 hours after PCI, the routine dose group of rosuvastatin, 72 hours after PCI operation in the routine dose group of atorvastatin lower than 24 hours after the operation, there was no statistical difference (P0.05), and 72 hours after PCI operation in the intensive dose group of rosuvastatin was 72 hours Lp-PLA2. The level was lower than 24 hours after the operation (P0.05), and the level of plasma Lp-PLA2 was positively correlated with the Gensini score of coronary artery disease in ACS patients (r=0.355, P=0.001), and the level of 5 Hs-CRP was zero correlation with the Gensini integral of coronary artery disease in ACS patients (P0.05). Conclusion: 1 the Lp-PLA2 level of plasma is better than the level of serum Hs-CRP. Changes in blood vessel damage, inflammatory response and plaque stability.2 enhanced dose of rosuvastatin treatment compared with conventional dose rosuvastatin and routine dose atorvastatin treatment, the better anti inflammatory effect of.3 plasma Lp-PLA2 level was positively correlated with coronary artery disease in ACS patients.
【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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