不同劑量瑞舒伐他汀治療對不穩(wěn)定型心絞痛患者PCI術后心肌損傷標志物及炎癥因子的影響
發(fā)布時間：2018-11-21 20:22
【摘要】：目的:通過對擬行擇期經皮冠狀動脈介入治療(PCI)的不穩(wěn)定型心絞痛患者術前給予不同劑量的瑞舒伐他汀,觀察其術后心肌損傷標志物的演變,如сTnΙ、СΚ-ΜΒ;與此同時,觀測炎癥因子—超敏C反應蛋白(hs-CRP)水平變化,來探討擇期PCI患者術前給予不同劑量瑞舒伐他汀治療對患者的心肌保護作用、炎癥因子的影響以及瑞舒伐他汀的安全性問題。方法:選取2015年6月-2016年12月于延安大學東關心腦血管病分院心內科收治的診斷為不穩(wěn)定型心絞痛并需要擬行擇期PCI術的患者80例,隨機分為A組(20mg/d)和B組(10mg/d),各組分別收錄40例患者;Α組于術前3天開始口服瑞舒伐他汀20mg每日,夜間頓服,術后改為10mg每日長期服用。Β組于術前3天開始口服瑞舒伐他汀鈣片10mg/次,每日一次,術后按上述劑量繼續(xù)服用。每個患者入院后予以采集各個時間段的сTnΙ、СΚ-ΜΒ、hs-CRP水平,分別為術前、PCI術后6h及24h。每個患者于術前、術后15天采血測定TC、TG、LDL-C、HDL-C,同時觀察其術后瑞舒伐他汀的副作用及術后1個月心血管不良事件的發(fā)生情況。整理所得的數據用SPSS20.0統(tǒng)計包做出進一步統(tǒng)計分析。結果:1.將Α、Β組患者的一般資料進行統(tǒng)計學分析,兩組間無統(tǒng)計學差異(P0.05)。2.Α、Β組患者術前血清сTnΙ、СΚ-ΜΒ濃度比較,無統(tǒng)計學差異(P0.05);A、B組患者PCI術后6小時血清сTnΙ、СΚ-ΜΒ濃度升高,但組間比較差異無統(tǒng)計學意義(P0.05)。Β組患者PCI術后24小時血清сTnΙ、СΚ-ΜΒ濃度升高程度相比較于Α組明顯,差異有統(tǒng)計學意義(P0.05)。A、B組患者各組內比較,術后6h和24h血清сTnΙ、СΚ-ΜΒ濃度較術前升高,差異有統(tǒng)計學意義(P0.05)。3.Α、Β組患者PCI術前、PCI術后6h血清hs-CRP水平比較,差異無統(tǒng)計學意義(Ρ0.05);術后24h血清hs-CRP水平較入院均升高,Β組較Α組升高明顯,差異有統(tǒng)計學意義(Ρ0.05)。A、B組患者各組內比較,術后6h和24h的血清hs-CRP水平較術前升高,差異有統(tǒng)計學意義(P0.05)。4.Α、Β兩組患者PCI術后15天血脂各項檢驗結果比較未見顯著性差異。5.A、B兩組患者術后出現(xiàn)他汀副作用的情況比較,未見顯著性差異。6.所有研究對象術后隨訪1個月,A、B兩組患者ΜΑСЕ事件發(fā)生率無統(tǒng)計學差異。結論:1.部分PCI術可導致術后心肌不同程度的損傷,引起一過性cTnI、CK-MB不同程度增高,導致部分病人臨床出現(xiàn)心絞痛等癥狀。2.術前給予20mg瑞舒伐他汀對心肌的保護、炎癥因子的抑制作用較10mg瑞舒伐他汀更明顯,且近期副作用無明顯增加,說明20mg瑞舒伐他汀能更好抑制PCI術后心肌損傷及炎癥反應。3.擇期PCI術前短期服用瑞舒伐他汀(20mg/d)具有良好的安全性。4.本試驗表明擇期PCI術前短期服用瑞舒伐他汀(20mg/d)能更好抑制PCI術后心肌損傷和炎癥反應,可以在臨床上推廣使用。
[Abstract]:Objective: to observe the changes of myocardial injury markers in patients with unstable angina pectoris (PCI) undergoing percutaneous coronary intervention (PCI) with different doses of resuvastatin before operation, such as Tn I, 尾-尾; At the same time, the changes of inflammatory factor-hypersensitive C-reactive protein (hs-CRP) levels were observed to investigate the myocardial protective effect of different doses of resuvastatin before selective PCI. Effects of inflammatory factors and safety of resuvastatin. Methods: 80 patients who were diagnosed as unstable angina pectoris from June 2015 to December 2016 in Department of Cardiology and Cerebrovascular Diseases of Dongguan University of Yan'an University and who need elective PCI operation were selected. They were randomly divided into two groups: group A (20mg/d) and group B (10mg/d). The 尾 group began to take resuvastatin 20mg daily at 3 days before operation and was given 10mg daily for a long time after operation. The 尾 group took resuvastatin calcium tablets once a day 3 days before operation, and continued to take it at the same dose after the operation. The levels of Tn I, K- 渭 b and hs-CRP in each time period were collected after admission, which were preoperation, 6h and 24h after PCI, respectively. TC,TG,LDL-C,HDL-C, was measured 15 days before operation and 15 days after operation. The side effects of recuvastatin and the occurrence of cardiovascular adverse events 1 month after operation were also observed. The collected data were further analyzed with SPSS20.0 statistical package. Results: 1. There was no statistical difference between the two groups (P0.05). 2. There was no statistical difference between the two groups (P0.05). In group A, the concentration of Tn I and 尾 in serum increased 6 hours after PCI, but there was no significant difference between the two groups (P0.05). The levels of Tn I and 尾 in serum were significantly higher in group A than in group A at 24 hours after PCI (P0.05). There was significant difference (P0.05). The serum levels of Tn I and 尾 were significantly higher in group A than those in group B at 6 h and 24 h after operation (P0.05) .3APAN, PCI in 尾 group was significantly higher than that in group B (P0.05). There was no significant difference in the level of serum hs-CRP 6 hours after PCI. The serum hs-CRP level was significantly higher in the 尾 group than in the 偽 group at 24 hours after operation, and the difference was statistically significant. The serum hs-CRP level in group A and B was significantly higher than that in the preoperative group at 6 h and 24 h after operation. The difference was statistically significant (P0.05). 4alpha, there was no significant difference in blood lipid test results between two groups of patients 15 days after PCI. 5. The side effects of statins in two groups of patients were compared. There was no significant difference. 6. All subjects were followed up for 1 month. There was no significant difference in the incidence of 渭 偽 events between the two groups. Conclusion: 1. Partial PCI can lead to different degree of myocardial injury after operation, cause transient increase of cTnI,CK-MB in different degrees, and lead to clinical symptoms of angina pectoris in some patients. 2. The protective effect of 20mg before operation on myocardium was more obvious than that of 10mg, and the side effects were not significantly increased in the near future, indicating that 20mg resuvastatin could better inhibit myocardial injury and inflammatory response after PCI. It is safe to take resuvastatin (20mg/d) for a short time before elective PCI. 4. This study suggests that short-term administration of resuvastatin (20mg/d) before elective PCI can better inhibit myocardial injury and inflammation after PCI, and can be popularized in clinic.
【學位授予單位】：延安大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4
本文編號：2348171
[Abstract]:Objective: to observe the changes of myocardial injury markers in patients with unstable angina pectoris (PCI) undergoing percutaneous coronary intervention (PCI) with different doses of resuvastatin before operation, such as Tn I, 尾-尾; At the same time, the changes of inflammatory factor-hypersensitive C-reactive protein (hs-CRP) levels were observed to investigate the myocardial protective effect of different doses of resuvastatin before selective PCI. Effects of inflammatory factors and safety of resuvastatin. Methods: 80 patients who were diagnosed as unstable angina pectoris from June 2015 to December 2016 in Department of Cardiology and Cerebrovascular Diseases of Dongguan University of Yan'an University and who need elective PCI operation were selected. They were randomly divided into two groups: group A (20mg/d) and group B (10mg/d). The 尾 group began to take resuvastatin 20mg daily at 3 days before operation and was given 10mg daily for a long time after operation. The 尾 group took resuvastatin calcium tablets once a day 3 days before operation, and continued to take it at the same dose after the operation. The levels of Tn I, K- 渭 b and hs-CRP in each time period were collected after admission, which were preoperation, 6h and 24h after PCI, respectively. TC,TG,LDL-C,HDL-C, was measured 15 days before operation and 15 days after operation. The side effects of recuvastatin and the occurrence of cardiovascular adverse events 1 month after operation were also observed. The collected data were further analyzed with SPSS20.0 statistical package. Results: 1. There was no statistical difference between the two groups (P0.05). 2. There was no statistical difference between the two groups (P0.05). In group A, the concentration of Tn I and 尾 in serum increased 6 hours after PCI, but there was no significant difference between the two groups (P0.05). The levels of Tn I and 尾 in serum were significantly higher in group A than in group A at 24 hours after PCI (P0.05). There was significant difference (P0.05). The serum levels of Tn I and 尾 were significantly higher in group A than those in group B at 6 h and 24 h after operation (P0.05) .3APAN, PCI in 尾 group was significantly higher than that in group B (P0.05). There was no significant difference in the level of serum hs-CRP 6 hours after PCI. The serum hs-CRP level was significantly higher in the 尾 group than in the 偽 group at 24 hours after operation, and the difference was statistically significant. The serum hs-CRP level in group A and B was significantly higher than that in the preoperative group at 6 h and 24 h after operation. The difference was statistically significant (P0.05). 4alpha, there was no significant difference in blood lipid test results between two groups of patients 15 days after PCI. 5. The side effects of statins in two groups of patients were compared. There was no significant difference. 6. All subjects were followed up for 1 month. There was no significant difference in the incidence of 渭 偽 events between the two groups. Conclusion: 1. Partial PCI can lead to different degree of myocardial injury after operation, cause transient increase of cTnI,CK-MB in different degrees, and lead to clinical symptoms of angina pectoris in some patients. 2. The protective effect of 20mg before operation on myocardium was more obvious than that of 10mg, and the side effects were not significantly increased in the near future, indicating that 20mg resuvastatin could better inhibit myocardial injury and inflammatory response after PCI. It is safe to take resuvastatin (20mg/d) for a short time before elective PCI. 4. This study suggests that short-term administration of resuvastatin (20mg/d) before elective PCI can better inhibit myocardial injury and inflammation after PCI, and can be popularized in clinic.
【學位授予單位】：延安大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R541.4
【參考文獻】
相關期刊論文 前10條
1 蔣金法;席鵬;;2015版歐洲心臟病學會非ST段抬高型急性冠脈綜合征指南要點推薦[J];世界臨床藥物;2016年11期
2 諸駿仁;高潤霖;趙水平;陸國平;趙冬;李建軍;;中國成人血脂異常防治指南(2016年修訂版)[J];中國循環(huán)雜志;2016年10期
3 陳偉偉;高潤霖;劉力生;朱曼璐;王文;王擁軍;吳兆蘇;李惠君;顧東風;楊躍進;鄭哲;蔣立新;胡盛壽;;《中國心血管病報告2015》概要[J];中國循環(huán)雜志;2016年06期
4 ;急性冠脈綜合征急診快速診療指南[J];中華危重癥醫(yī)學雜志(電子版);2016年02期
5 羅顯洪;夏豪;唐東梁;余太輝;;溶血磷脂酸對于評估不穩(wěn)定心絞痛患者不良預后的臨床意義[J];安徽醫(yī)藥;2015年09期
6 王海燕;;C-反應蛋白在產科的應用進展[J];繼續(xù)醫(yī)學教育;2015年08期
7 李文杰;張方;;高敏C反應蛋白在急性冠脈綜合征中的變化趨勢[J];中西醫(yī)結合心腦血管病雜志;2015年09期
8 胡方勇;徐飛;項鵬;;不同劑量阿托伐他汀對急性冠脈綜合征患者PCI圍術期腎功能及血清C反應蛋白的影響[J];現(xiàn)代中西醫(yī)結合雜志;2015年22期
9 官慧明;;探討聯(lián)合抗栓治療心肌梗死的臨床療效[J];當代醫(yī)學;2015年19期
10 宋玉新;;養(yǎng)心通絡湯聯(lián)合西藥治療冠心病心絞痛臨床研究[J];四川中醫(yī);2015年06期
，本文編號：2348171
本文鏈接：http://sikaile.net/yixuelunwen/xxg/2348171.html
最近更新
教材專著
