強(qiáng)化他汀治療在急性冠脈綜合癥患者急診PCI術(shù)中相關(guān)因素分析
發(fā)布時(shí)間：2019-04-28 07:59
【摘要】：目的:本實(shí)驗(yàn)通過研究急診PCI術(shù)前給予強(qiáng)化他汀藥物治療對(duì)急性冠脈綜合癥患者外周循環(huán)血液中內(nèi)皮微粒(EMPs)和(或)高敏C反應(yīng)蛋白(hs-CRP)水平的影響,來討論強(qiáng)化他汀抑制患者內(nèi)皮細(xì)胞的炎癥反應(yīng)以及觀察術(shù)后患者強(qiáng)化他汀治療的安全性和短期內(nèi)心血管不良事件的發(fā)生。方法:選取延安大學(xué)附屬醫(yī)院心內(nèi)科住院期間行急診PCI術(shù)的ACS患者100例,按隨機(jī)方法分為兩組,強(qiáng)化組:患者50例,急診PCI術(shù)前頓服阿托伐他汀鈣4片(80mg),術(shù)后堅(jiān)持服用3個(gè)月(40mg);常規(guī)組:患者50例,急診PCI術(shù)前頓服阿托伐他汀鈣1片(20mg),術(shù)后堅(jiān)持服用3個(gè)月(20mg);分別在入院時(shí)、PCI術(shù)后即刻和PCI后24h3個(gè)時(shí)間段采取患者靜脈血液,患者血漿中內(nèi)皮微粒(EMPs)水平用流式細(xì)胞術(shù)檢測(cè),血清中超敏C反應(yīng)蛋白(hs-CRP)水平用酶聯(lián)免疫比濁法測(cè)定,從中分析兩組血漿EMPs水平和血清hs-CRP水平間的變化,同時(shí)觀察術(shù)中兩組PCI術(shù)中冠脈TIMI血流情況和術(shù)后3個(gè)月內(nèi)他汀藥物副作用及總的MACE事件發(fā)生率。結(jié)果:1.兩組患者之間血漿EMPs水平在各個(gè)時(shí)間點(diǎn)的比較:入院時(shí)比較,兩組間患者血漿中EMPs的水平,P=0.5250.05,兩組間無統(tǒng)計(jì)學(xué)意義;術(shù)后即刻間比較:較入院時(shí)兩組患者血漿中EMPs的水平均升高(P0.05),且強(qiáng)化組血漿中EMPs的水平低于常規(guī)組;術(shù)后24h與術(shù)后即刻間的比較:較術(shù)后即刻兩組患者血漿中EMPs的水平較術(shù)后即刻均降低(P0.05),而且強(qiáng)化組降低的更為明顯。2.兩組間患者各個(gè)時(shí)間點(diǎn)的血清中hs-CRP水平比較:入院時(shí)比較:兩組患者在血清中hs-CRP水平比較,P=0.5690.05,兩組間無統(tǒng)計(jì)學(xué)意義;術(shù)后即刻間比較:較入院時(shí)兩組患者在血清中hs-CRP的水平較入院時(shí)均升高(P0.05),而且強(qiáng)化組較常規(guī)組血清中hs-CRP的水平低;術(shù)后24h與術(shù)后即刻間的比較:較術(shù)后即刻兩組患者PCI后24h血清中hs-CRP的水平均降低(P0.05),而且強(qiáng)化組降低的更為顯著。3.兩組患者血漿EMPs水平與血清hs-CRP水平間的關(guān)系:根據(jù)相關(guān)性結(jié)果分析,血漿EMPs水平和血清hs-CRP水平間相關(guān)性較差(0r0.4,P0.05)。4.患者介入術(shù)中冠脈TIMI血流情況強(qiáng)化組和常規(guī)組比較:50例強(qiáng)化組中TIMI血流有效改善的患者47例(94%),50例常規(guī)組中有效的患者40例(80%),兩組患者急診術(shù)中冠脈TIMI血流改善情況的比較,P=0.037(P0.05),表明差異有統(tǒng)計(jì)學(xué)意義,可認(rèn)為術(shù)前口服強(qiáng)化他汀藥物可以改善急診PCI術(shù)中冠脈血流,降低無復(fù)流的發(fā)生。5.安全性評(píng)價(jià):術(shù)后3個(gè)月強(qiáng)化組與常規(guī)組在服用他汀藥物發(fā)生副作用概率的比較:P=0.7120.05,差異無統(tǒng)計(jì)學(xué)意義,表明強(qiáng)化組與常規(guī)組兩組間他汀副作用發(fā)生概率并無差別。術(shù)后3個(gè)月內(nèi)兩組患者總的MACE事件發(fā)生率比較P=0.0360.05,差異有統(tǒng)計(jì)學(xué)意義,可認(rèn)為術(shù)前強(qiáng)化他汀治療可降低近期患者M(jìn)ACE的發(fā)生率。結(jié)論:1.血漿EMPs及血清hs-CRP可間接反映急性冠脈綜合癥患者急診PCI中冠脈內(nèi)皮細(xì)胞炎癥反應(yīng)和損傷程度;2.強(qiáng)化他汀可降低患者急診PCI術(shù)后血漿EMPs及血清hs-CRP水平,改善術(shù)中冠脈血流,降低短期內(nèi)患者發(fā)生心血管不良事件;3.血漿EMPs水平和血清hs-CRP水平兩者間的相關(guān)性較差;4.強(qiáng)化他汀與常規(guī)他汀藥物治療在安全性上無明顯差別。
[Abstract]:Objective: To study the effect of intensive statin therapy on the level of endothelial particles (EMPs) and/ or high-sensitive C-reactive protein (hs-CRP) in peripheral circulating blood of patients with acute coronary syndrome. To discuss the enhancement of the inflammatory response of the statin to the endothelial cells of the patient and to observe the safety and short-term cardiovascular adverse events of the post-operative patient's enhanced statin therapy. Methods:100 patients with ACS who underwent emergency PCI were randomly divided into two groups according to the random method. The patients were divided into two groups according to the random method:50 cases of the patients,50 cases of the patients with emergency PCI,4 tablets of atorvastatin calcium (80 mg), and 3 months (40 mg) after the operation; 50 of the patients,1 tablet (20 mg) of atorvastatin calcium in emergency PCI, and 3 months (20 mg) after the operation; respectively, the patient's venous blood was taken at the time of admission, immediately after PCI and 24 hours after PCI, and the level of endothelial particles (EMPs) in the plasma of the patient was detected by flow cytometry. The serum levels of EMPs and hs-CRP in serum were measured by enzyme-linked immunosorbent assay (ELISA) in serum. Results:1. The level of EMPs in plasma of the two groups was significantly higher than that of the two groups at the time of admission (P = 0.525.05). There was no statistical significance between the two groups. The level of EMPs in plasma of the two groups was higher than that of the two groups at the time of admission (P0.05). The levels of EMPs in the plasma of the group were lower than that of the conventional group, and the levels of EMPs in the plasma of the two groups were decreased immediately after the operation (P0.05). The levels of hs-CRP in the serum of the two groups were compared with that of the two groups: the level of hs-CRP in the two groups was significantly higher in the two groups, P = 0.5690.05, no statistical significance between the two groups, and the level of hs-CRP in the two groups at the time of admission was higher than that at the time of admission (P0.05). In addition, the level of hs-CRP in the serum of the group was lower than that in the conventional group, and the level of hs-CRP in the 24 h serum after the operation was decreased (P0.05). The relationship between plasma EMPs and hs-CRP levels in the two groups was related to the correlation between the levels of EMPs and hs-CRP levels in the serum (0r0.4, P0.05). Compared with the conventional group, there were 47 patients (94%) and 40 (80%) of the 50 patients who had effective TIMI flow in the enhanced group, and 40 (80%) of the 50 patients in the conventional group, and the improvement of the coronary TIMI flow during the emergency operation of the two groups (P = 0.037 (P0.05). The difference is of statistical significance, and it can be considered that the pre-operative oral enhancement of statins can improve the coronary blood flow in emergency PCI and reduce the occurrence of no-reflow. Safety evaluation: There was no significant difference in the probability of side effects between the two groups after the operation. P = 0.7120.05, the difference was not statistically significant, indicating that there was no difference in the probability of the side effects between the two groups. The incidence of MACE events in the two groups was significantly higher than that of P = 0.0360.05 in 3 months after operation, and the difference was of statistical significance, and it was considered that preoperative intensive statin therapy could reduce the incidence of MACE in recent patients. Conclusion:1. Plasma EMPs and hs-CRP can indirectly reflect the degree of inflammatory response and injury of coronary endothelial cells in emergency PCI of patients with acute coronary syndrome. To enhance the level of plasma EMPs and serum hs-CRP in patients with emergency PCI, and to improve the coronary flow in the operation and to reduce the occurrence of cardiovascular adverse events in the short term. The correlation between the plasma EMPs level and the serum hs-CRP level was poor;4. There was no significant difference in safety between the enhancement of statins and conventional statin therapy.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R541.4
[Abstract]:Objective: To study the effect of intensive statin therapy on the level of endothelial particles (EMPs) and/ or high-sensitive C-reactive protein (hs-CRP) in peripheral circulating blood of patients with acute coronary syndrome. To discuss the enhancement of the inflammatory response of the statin to the endothelial cells of the patient and to observe the safety and short-term cardiovascular adverse events of the post-operative patient's enhanced statin therapy. Methods:100 patients with ACS who underwent emergency PCI were randomly divided into two groups according to the random method. The patients were divided into two groups according to the random method:50 cases of the patients,50 cases of the patients with emergency PCI,4 tablets of atorvastatin calcium (80 mg), and 3 months (40 mg) after the operation; 50 of the patients,1 tablet (20 mg) of atorvastatin calcium in emergency PCI, and 3 months (20 mg) after the operation; respectively, the patient's venous blood was taken at the time of admission, immediately after PCI and 24 hours after PCI, and the level of endothelial particles (EMPs) in the plasma of the patient was detected by flow cytometry. The serum levels of EMPs and hs-CRP in serum were measured by enzyme-linked immunosorbent assay (ELISA) in serum. Results:1. The level of EMPs in plasma of the two groups was significantly higher than that of the two groups at the time of admission (P = 0.525.05). There was no statistical significance between the two groups. The level of EMPs in plasma of the two groups was higher than that of the two groups at the time of admission (P0.05). The levels of EMPs in the plasma of the group were lower than that of the conventional group, and the levels of EMPs in the plasma of the two groups were decreased immediately after the operation (P0.05). The levels of hs-CRP in the serum of the two groups were compared with that of the two groups: the level of hs-CRP in the two groups was significantly higher in the two groups, P = 0.5690.05, no statistical significance between the two groups, and the level of hs-CRP in the two groups at the time of admission was higher than that at the time of admission (P0.05). In addition, the level of hs-CRP in the serum of the group was lower than that in the conventional group, and the level of hs-CRP in the 24 h serum after the operation was decreased (P0.05). The relationship between plasma EMPs and hs-CRP levels in the two groups was related to the correlation between the levels of EMPs and hs-CRP levels in the serum (0r0.4, P0.05). Compared with the conventional group, there were 47 patients (94%) and 40 (80%) of the 50 patients who had effective TIMI flow in the enhanced group, and 40 (80%) of the 50 patients in the conventional group, and the improvement of the coronary TIMI flow during the emergency operation of the two groups (P = 0.037 (P0.05). The difference is of statistical significance, and it can be considered that the pre-operative oral enhancement of statins can improve the coronary blood flow in emergency PCI and reduce the occurrence of no-reflow. Safety evaluation: There was no significant difference in the probability of side effects between the two groups after the operation. P = 0.7120.05, the difference was not statistically significant, indicating that there was no difference in the probability of the side effects between the two groups. The incidence of MACE events in the two groups was significantly higher than that of P = 0.0360.05 in 3 months after operation, and the difference was of statistical significance, and it was considered that preoperative intensive statin therapy could reduce the incidence of MACE in recent patients. Conclusion:1. Plasma EMPs and hs-CRP can indirectly reflect the degree of inflammatory response and injury of coronary endothelial cells in emergency PCI of patients with acute coronary syndrome. To enhance the level of plasma EMPs and serum hs-CRP in patients with emergency PCI, and to improve the coronary flow in the operation and to reduce the occurrence of cardiovascular adverse events in the short term. The correlation between the plasma EMPs level and the serum hs-CRP level was poor;4. There was no significant difference in safety between the enhancement of statins and conventional statin therapy.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R541.4
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