不同剂量阿托伐他汀对PCI患者脂联素、网膜素-1水平及MACE事件的影响

发布时间：2018-04-23 15:15

本文选题：冠心病 + 阿托伐他汀　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:本研究选取行PCI术的冠心病患者,探讨不同剂量阿托伐他汀钙片(Atorvastatin)对患者血清超敏C反应蛋白(hypersensitive C-reactive protein)、脂联素(Adiponectin)、网膜素-1(Omentin-1)水平的影响,并观察患者1年主要不良心血管事件(MACE)的发生情况,以便更好的为心血管疾病的预防和临床治疗提供理论依据以及能够找到阿托伐他汀用于减轻PCI术后炎性反应的合理剂量。方法:1临床上选取河北医科大学附属唐山工人医院心内一科2015年1月1日至2016年1月1日期间住院的行PCI术的冠心病患者111例,记录所有患者的年龄、性别、身体质量指数等一般临床资料。将入院后的所有患者随机分为40 mg高剂量A组和20 mg低剂量B组,A组56例,男性30例,女性26例,年龄48~74(58.52±11.87岁),给予口服阿托伐他汀钙片40 mg/d。B组55例,男性27例,女性28例,年龄47~72(58.69±10.25岁),给予口服阿托伐他汀钙片20 mg/d。2检测并记录患者入院前、术后3天、术后3个月的总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hs-CRP)、APN、Omentin-1的水平,并观察两组患者3个月后的药物不良反应发生情况和1年的MACE事件的发生情况。3实验检测方法采用酶联免疫吸附法(ELISA)分别测定不同时间间隔两组患者的血清hs-CRP、APN和Omentin-1的浓度,比较两组之间的差异。4统计学方法:应用统计学软件SPSS 21.0对收集的数据进行分析,服从正态分布的计量资料以均数±标准差(`x±s)的形式表示,不服从正态分布的资料采用中位数(四分位数)表示,计量资料两组之间的比较采用t检验,计数资料两组间率的比较运用χ2检验,检验水平采用标准为P0.05认为差异有统计学意义。结果:1通过对两组患者的年龄、性别比例、BMI、冠状动脉病变情况、置入支架数量以及入院前各项血脂指标进行比较,结果为差异无统计学意义(均P0.05)。2 40 mg高剂量A组和20 mg低剂量B组患者入院前血清的hs-CRP、APN、Omentin-1水平相比较,差异无统计学意义(均P0.05)。3术后3个月40 mg高剂量A组和20 mg低剂量B组TC、TG水平均较入院前明显降低(3.66±0.45 mmol/L)vs(4.14±0.46 mmol/L);(1.09±0.30 mmol/L)vs(1.51±0.28 mmol/L),均P0.05,差异有统计学意义,且40 mg高剂量A组指标明显低于20 mg低剂量B组(P0.05)。4术后3天、术后3个月40 mg高剂量A组和20 mg低剂量B组hs-CRP水平均较入院前明显降低(P0.05),差异有统计学意义。术后3天、术后3个月两组APN、Omentin-1水平均较入院前明显升高(P0.05),差异有统计学意义。且术后3个月A组hs-CRP明显低于B组(3.12±0.85 mg/L)vs(4.36±1.22 mg/L),P0.05,差异有统计学意义。APN、Omentin-1水平A组明显高于B组(14.2±2.55 mg/L)vs(8.78±3.16 mg/L);(28.9±9.59 ng/ml)vs(21.6±6.29 ng/ml),P0.05,差异有统计学意义。5 40 mg高剂量A组和20 mg低剂量B组患者服用阿托伐他汀后随访3个月时患者的药物不良反应发生情况,A组药物不良反应发生率为12.5%,B组药物不良反应发生率为10.0%,P0.05,为差异无统计学意义。A、B组两组1年的MACE事件发生率分别为10.7%,27.3%,两组间比较,P0.05,差异有统计学意义,40 mg高剂量组MACE事件发生情况明显低于20mg组。结论:1服用阿托伐他汀40 mg高剂量组和20 mg低剂量组相比,高剂量组患者血脂指标TC、TG水平降低更明显,血清hs-CRP水平降低更明显,APN、Omentin-1升高更明显,1年内MACE事件发生情况较低。2阿托伐他汀可以降低PCI患者血清hs-CRP的水平,提高患者血清APN和Omentin-1浓度,高剂量组能够明显减轻PCI术后患者的炎性反应,从而更好的保护心血管系统。3 40 mg阿托伐他汀是强效而安全的,对心血管系统具有保护作用。
[Abstract]:Objective: To investigate the effects of different doses of Atorvastatin Calcium Tablets (Atorvastatin) on serum hypersensitivity C reactive protein (hypersensitive C-reactive protein), adiponectin (Adiponectin) and omentin -1 (Omentin-1) in patients with PCI (Atorvastatin), and to observe the incidence of 1 years of major adverse cardiovascular events (MACE) in patients. In order to provide a better theoretical basis for the prevention and clinical treatment of cardiovascular diseases and to find a reasonable dose of atorvastatin for alleviating the inflammatory response after PCI. Methods: 1 clinical selection of PCI in the hospital of Tangshan workers' Hospital Affiliated to Hebei Medical University from January 1, 2015 to January 1, 2016 was selected. 111 patients with coronary heart disease were recorded in all patients' age, sex, body mass index and other general clinical data. All patients after admission were randomly divided into 40 mg high dose A group and 20 mg low dose B group, A group 56 cases, male 30 cases, female 26 cases, age 48~74 (58.52 + 11.87 years), and 55 cases of oral Atorvastatin Calcium Tablets 40 mg/d.B group, male 27. Cases, 28 women, aged 47~72 (58.69 + 10.25 years), were given an oral Atorvastatin Calcium Tablets 20 mg/d.2 test and recorded the total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), C reactive protein (hs-CRP), APN, Omentin-1 in 3 months after operation, 3 days after operation, and 3 months after two groups of patients. The occurrence of adverse drug reactions and the occurrence of MACE events in 1 years.3 experimental detection method using enzyme linked immunosorbent assay (ELISA) to determine the concentration of serum hs-CRP, APN and Omentin-1 at different time intervals, and to compare the difference between the two groups by.4 statistics method: the application statistics software SPSS 21 for the collected data into the data. In line analysis, the measurement data obeying the normal distribution are expressed in the form of mean number + standard deviation (`x + s). The data that do not obey the normal distribution are expressed in the median (four digits). The comparison between the two groups of the measured data is tested by t test. The comparison of the rate of the count data between the two groups uses the chi square 2 test, and the test level uses the standard as P0.05 that the difference is unified. Results: 1 by comparing the age, sex ratio, BMI, coronary artery disease, the number of stent placement and the blood lipid indexes before admission, the results were not statistically significant (P0.05).2 40 mg high dose A group and 20 mg low dose B group were compared with the serum hs-CRP, APN, Omentin-1 levels before admission. The difference was not statistically significant (P0.05).3 3 months 40 mg high dose A group and 20 mg low dose B group TC, the level of TG was significantly lower than before admission (3.66 + 0.45 mmol/L) vs (4.14 + 0.46 mmol/L), (1.09 + 0.30 mmol/L) (1.51 + 0.28), both of which were statistically significant, and the high dose of 40 3 days after group B (P0.05).4, 3 months after operation 40 mg high dose A group and 20 mg low dose B group, hs-CRP level was significantly lower than before admission (P0.05), the difference was statistically significant. 3 days after the operation, two groups of APN, Omentin-1 level were significantly higher than before admission (P0.05), the difference was statistically significant. And 3 months after the operation obviously lower than the group (3.12 + 0.85 mg/L) vs (4.36 + 1.22 mg/L), P0.05, the difference was statistically significant.APN, Omentin-1 level A group was significantly higher than that of B group (14.2 + 2.55 mg/L) vs (8.78 + 3.16 mg/L), (28.9 + 9.59 ng/ml) (28.9 + 9.59 ng/ml) (21.6 + 6.29). In patients with adverse drug reactions, the incidence of adverse drug reactions in group A was 12.5%, and the incidence of adverse drug reactions in group B was 10%, P0.05 was not statistically significant.A. The incidence of MACE events in two groups of two groups in group B was 10.7%, 27.3%, and two groups were compared, P0.05, the difference was statistically significant, the 40 mg high dose group MACE event happened. The situation was significantly lower than that in the 20mg group. Conclusion: 1 compared with the high dose of atorvastatin 40 mg high dose group and 20 mg low dose group, the blood lipid index of the high dose group was TC, the TG level decreased more obviously, the serum hs-CRP level decreased more obviously, the APN, Omentin-1 increased more obviously, the MACE event occurred in the 1 years, and the.2 atorvastatin could reduce the PCI patient's serum hs-C. The level of RP increases the concentration of APN and Omentin-1 in the patient's serum. The high dose group can significantly reduce the inflammatory response in the patients after PCI, thus better protection of the cardiovascular system.3 40 mg atorvastatin is strong and safe, and has protective effects on the cardiovascular system.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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