氯吡格雷或阿托伐他汀強(qiáng)化治療對(duì)老年心肌梗死療效的影響
發(fā)布時(shí)間：2018-12-15 07:13
【摘要】：目的急性心肌梗死(acute myocardial infarction,AMI)是冠心病的最嚴(yán)重類型,是臨床上導(dǎo)致心源性猝死的主要病因,患者臨床上通常表現(xiàn)為胸悶、心律失常、休克甚至心衰。本課題旨在分析氯吡格雷強(qiáng)化或阿托伐他汀強(qiáng)化治療對(duì)老年急性心肌梗死的不同治療效果和MACE事件發(fā)生率的變化以及藥物臨床副作用的觀察研究,并探討治療過程中相關(guān)的炎癥反應(yīng)因子、氧化-抗氧化蛋白、內(nèi)皮生長(zhǎng)因子和轉(zhuǎn)化生長(zhǎng)因子水平變化,進(jìn)而為臨床治療提供參考。方法分析本院2009年1月至2015年10月期間診治的老年急性心肌梗死患者臨床資料。300例患者中男180例,女120例,年齡66-78歲,平均72.9±5.1歲。所有患者均符合中華醫(yī)學(xué)會(huì)心血管分會(huì)在2015年制定的《急性ST段抬高心肌梗死診斷和治療指南》中關(guān)于急性心肌梗死的診斷標(biāo)準(zhǔn)。所有病人都給予符合急性心肌梗死指南的治療(即阿司匹林、阿托伐他汀、氯吡格雷,低分子肝素β受體阻滯劑,ACEI類藥物等)均接受PCI治療。實(shí)驗(yàn)觀察時(shí)間為一個(gè)月,標(biāo)準(zhǔn)治療組人數(shù)為115人,劑量:阿司匹林100mg,氯吡格雷75mg,阿托伐他汀20mg;氯吡格雷強(qiáng)化組人數(shù)為95人,劑量:阿司匹林100mg,氯吡格雷150mg,阿托伐他汀20mg;阿托伐他汀強(qiáng)化組人數(shù)為90人,劑量:阿司匹林100mg,氯吡格雷75mg,阿托伐他汀40mg。各組按研究方案完成治療后,對(duì)各組患者的臨床治療進(jìn)行MACE分析和臨床副作用的觀察比較以及治療前后血清中炎癥反應(yīng)因子、氧化-抗氧化酶及VEGF和TGFβ蛋白水平變化。結(jié)果1.同標(biāo)準(zhǔn)治療組相比,阿托伐他汀強(qiáng)化組與氯吡格雷強(qiáng)化組的MACE事件發(fā)生率明顯降低(P0.05);而阿托伐他汀強(qiáng)化組同氯吡格雷強(qiáng)化組的MACE事件發(fā)生率無統(tǒng)計(jì)學(xué)意義(P0.05)。2.與標(biāo)準(zhǔn)治療組相比,阿托伐他汀強(qiáng)化組與氯吡格雷強(qiáng)化組患者合并出血、胃腸道反應(yīng)、粒細(xì)胞減少、肌病、肝酶異常等副作用無顯著統(tǒng)計(jì)學(xué)差異(P0.05)。3.與標(biāo)準(zhǔn)治療組和氯吡格雷強(qiáng)化組相比,阿托伐他汀強(qiáng)化組老年急性心肌梗死患者血清中反應(yīng)性炎癥因子水平均有明顯的抑制作用且差異存在顯著統(tǒng)計(jì)學(xué)意義(P0.05);而比較標(biāo)準(zhǔn)治療組和氯吡格雷強(qiáng)化組,兩組間無明顯統(tǒng)計(jì)學(xué)差異(P0.05)。4.與標(biāo)準(zhǔn)治療組患者相比,MDA水平在氯吡格雷強(qiáng)化組和阿托伐他汀強(qiáng)化組患者血清中被顯著抑制;而SOD、CAT和GSHPX等蛋白在氯吡格雷強(qiáng)化組和阿托伐他汀強(qiáng)化組組中則明顯高表達(dá),且差異均存在顯著統(tǒng)計(jì)學(xué)意義(P0.05)。5.與標(biāo)準(zhǔn)治療組相比,氯吡格雷強(qiáng)化組和阿托伐他汀強(qiáng)化組患者血清中TGF-β及VEGF蛋白表達(dá)有明顯的抑制作用,且差異存在顯著統(tǒng)計(jì)學(xué)意義(P0.05),結(jié)論氯吡格雷或阿托伐他汀強(qiáng)化治療對(duì)老年急性心肌梗死患者可產(chǎn)生保護(hù)性的治療效果且不良反應(yīng)發(fā)生率無明顯升高,其藥理機(jī)制可能與調(diào)節(jié)患者病變血管的炎癥反應(yīng)和氧化-抗氧化水平狀態(tài)有關(guān)。
[Abstract]:Objective Acute Myocardial Infarction (acute myocardial infarction,AMI) is the most serious type of coronary heart disease and is the main cause of sudden cardiac death. The clinical manifestations of patients are chest tightness arrhythmia shock and even heart failure. The purpose of this study was to analyze the effects of clopidogrel intensification or Atto vastatin intensive therapy on elderly patients with acute myocardial infarction (AMI) and the changes of MACE events and the clinical side effects of drugs. The changes of inflammatory response factor, oxidation-antioxidation protein, endothelial growth factor and transforming growth factor in the course of treatment were also discussed in order to provide reference for clinical treatment. Methods the clinical data of 300 elderly patients with acute myocardial infarction (AMI) from January 2009 to October 2015 were analyzed. There were 180 males and 120 females, aged from 66 to 78 years, with an average age of 72.9 鹵5.1 years. All the patients were in accordance with the diagnostic criteria for acute ST segment elevation myocardial infarction (AMI) developed by the Chinese Medical Association Cardiovascular Society in 2015. All patients were treated with PCI (aspirin, Atto statins, clopidogrel, low molecular weight heparin 尾 receptor blockers, ACEI drugs, etc.) in accordance with the guidelines for acute myocardial infarction. The experimental observation time was one month, the standard treatment group was 115 people, the dosage of aspirin was 100 mg, clopidogrel 75 mg, Atto vastatin 20 mg; The dosage of clopidogrel was 100 mg aspirin, 150 mg clopidogrel, 20 mg Atto vastatin and 90 cases Atto vastatin plus aspirin 100 mg, clopidogrel 75 mg, Atto vastatin 40 mg. After the treatment was completed according to the study plan, the MACE analysis and the clinical side effects were observed and compared. The levels of serum inflammatory response factor, oxidation-antioxidant enzyme, VEGF and TGF 尾 protein were compared before and after the treatment. Result 1. Compared with the standard treatment group, the incidence of MACE events in the Atto vastatin group and clopidogrel group was significantly lower (P0.05). However, there was no significant difference in the incidence of MACE events between the Atto and clopidogrel groups (P0.05). Compared with the standard treatment group, there was no significant difference in side effects such as hemorrhage, gastrointestinal reaction, granulocytopenia, myopathy and liver enzyme abnormality between Atto and clopidogrel groups (P0.05). Compared with the standard treatment group and clopidogrel group, the serum levels of reactive inflammatory factors in the elderly patients with acute myocardial infarction were significantly inhibited by Atto vastatin (P0.05). The standard treatment group and clopidogrel reinforcement group, there was no significant difference between the two groups (P0.05). Compared with the standard treatment group, MDA levels were significantly inhibited in clopidogrel group and Atto vastatin group. The expression of SOD,CAT and GSHPX was significantly higher in clopidogrel group and Atto vastatin group, and the difference was statistically significant (P0.05). Compared with the standard treatment group, the expression of TGF- 尾 and VEGF protein in serum of clopidogrel group and Atto vastatin group were significantly inhibited, and the difference was statistically significant (P0.05). Conclusion intensive therapy with clopidogrel or Atto vastatin has protective effect on elderly patients with acute myocardial infarction and the incidence of adverse reactions is not significantly increased. Its pharmacological mechanism may be related to the regulation of inflammatory response and oxidation-antioxidation state of the diseased vessels.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R542.22
本文編號(hào)：2380222
[Abstract]:Objective Acute Myocardial Infarction (acute myocardial infarction,AMI) is the most serious type of coronary heart disease and is the main cause of sudden cardiac death. The clinical manifestations of patients are chest tightness arrhythmia shock and even heart failure. The purpose of this study was to analyze the effects of clopidogrel intensification or Atto vastatin intensive therapy on elderly patients with acute myocardial infarction (AMI) and the changes of MACE events and the clinical side effects of drugs. The changes of inflammatory response factor, oxidation-antioxidation protein, endothelial growth factor and transforming growth factor in the course of treatment were also discussed in order to provide reference for clinical treatment. Methods the clinical data of 300 elderly patients with acute myocardial infarction (AMI) from January 2009 to October 2015 were analyzed. There were 180 males and 120 females, aged from 66 to 78 years, with an average age of 72.9 鹵5.1 years. All the patients were in accordance with the diagnostic criteria for acute ST segment elevation myocardial infarction (AMI) developed by the Chinese Medical Association Cardiovascular Society in 2015. All patients were treated with PCI (aspirin, Atto statins, clopidogrel, low molecular weight heparin 尾 receptor blockers, ACEI drugs, etc.) in accordance with the guidelines for acute myocardial infarction. The experimental observation time was one month, the standard treatment group was 115 people, the dosage of aspirin was 100 mg, clopidogrel 75 mg, Atto vastatin 20 mg; The dosage of clopidogrel was 100 mg aspirin, 150 mg clopidogrel, 20 mg Atto vastatin and 90 cases Atto vastatin plus aspirin 100 mg, clopidogrel 75 mg, Atto vastatin 40 mg. After the treatment was completed according to the study plan, the MACE analysis and the clinical side effects were observed and compared. The levels of serum inflammatory response factor, oxidation-antioxidant enzyme, VEGF and TGF 尾 protein were compared before and after the treatment. Result 1. Compared with the standard treatment group, the incidence of MACE events in the Atto vastatin group and clopidogrel group was significantly lower (P0.05). However, there was no significant difference in the incidence of MACE events between the Atto and clopidogrel groups (P0.05). Compared with the standard treatment group, there was no significant difference in side effects such as hemorrhage, gastrointestinal reaction, granulocytopenia, myopathy and liver enzyme abnormality between Atto and clopidogrel groups (P0.05). Compared with the standard treatment group and clopidogrel group, the serum levels of reactive inflammatory factors in the elderly patients with acute myocardial infarction were significantly inhibited by Atto vastatin (P0.05). The standard treatment group and clopidogrel reinforcement group, there was no significant difference between the two groups (P0.05). Compared with the standard treatment group, MDA levels were significantly inhibited in clopidogrel group and Atto vastatin group. The expression of SOD,CAT and GSHPX was significantly higher in clopidogrel group and Atto vastatin group, and the difference was statistically significant (P0.05). Compared with the standard treatment group, the expression of TGF- 尾 and VEGF protein in serum of clopidogrel group and Atto vastatin group were significantly inhibited, and the difference was statistically significant (P0.05). Conclusion intensive therapy with clopidogrel or Atto vastatin has protective effect on elderly patients with acute myocardial infarction and the incidence of adverse reactions is not significantly increased. Its pharmacological mechanism may be related to the regulation of inflammatory response and oxidation-antioxidation state of the diseased vessels.
【學(xué)位授予單位】：鄭州大學(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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