急性冠脉综合征患者采用短期强化他汀治疗对肾功能的影响

发布时间：2018-05-11 16:42

本文选题：急性冠脉综合征 + 降血脂药　；参考：《南京医科大学》2017年硕士论文

【摘要】：[背景]冠心病(coronary heart disease,CHD)尤其是急性冠状动脉综合征(acute coronary syndrome,ACS),随着人口老龄化的进展,已成为导致人类死亡的头号杀手。ACS发生最主要的病理生理机制为冠状动脉粥样硬化斑块破裂、血管痉挛和随之发生的血小板聚集所引起的血栓形成。而根据胸痛时的患者心电图变化,ACS可分为非ST段抬高型ACS和ST段抬高型心肌梗死。其中前者包括有包括不稳定型心绞痛(unstable angina,UA)和非ST段抬高型心肌梗死(Non-ST-segment elevation myocardial infarction,NSTEMI)。近些年来,随着 ACS 介入治疗技术的不断发展和治疗药物的不断研发生产,使ACS患者的病死率和发病率明显降低。伴随着中国人民人均寿命的延长,ACS发病不仅在高龄人群中比例不断升高,还逐渐呈现年轻化的趋势。随着冠心病患者人数的增加,慢性肾脏病在冠心病中的发生、发展得到越来越多关注,两种疾病的关系错综复杂。患有慢性肾脏病的患者,冠心病的发病率和死亡率明显增加已得到共识。研究表明,轻度慢性肾功能异常患者,即使无冠心病危险因素,冠脉动脉疾病,左心室肥厚、慢性心力衰竭和脑卒中的发生率亦明显增加。他汀类药物目前已广泛应用于CHD患者的治疗,他是一种3-羟基-3-甲基戊二酰辅酶A(HMG-Co A)还原酶抑制剂,不仅具有降血脂、抑制胆固醇合成的作用,还能抗炎、抗氧化应激、改善机体血管内皮的功能。有研究显示,他汀类药物可通过其抗氧化、抗炎症、抗血栓、保护内皮细胞、诱导血管紧张素受体下调、减少内皮素合成等独立于降脂之外的作用,而对肾脏有一定的保护作用。本研究拟通过比较短期强化剂量他汀类药物治疗的ACS患者与标准剂量他汀类药物治疗的ACS患者对肾功能的影响,评价强化他汀药物治疗对肾功能的安全性与疗效。[目的]通过比较短期强化剂量他汀类药物治疗与标准剂量他汀类药物治疗,评价强化他汀药物治疗对肾功能的安全性与疗效。[方法]病例选取2013年3月-2016年10月在杭州市第一人民医院接受诊疗的急性冠脉综合症的患者200例,患者按单双号随机分成强化阿托伐他汀治疗组(40mg)与常规阿托伐他汀治疗组(20mg)。阿托伐他汀强化剂量治疗组住院期间及出院后予以40mg/N;阿托伐他汀常规治疗组住院及出院采用阿托伐他汀标准剂量(20mg/N.口服)治疗。分别于服药前及服药后行检测患者血脂、肝功能、高敏C反应蛋白(hs-crp)、肌酸激酶(CK)、血肌酐水平及肾小球滤过率的指标,同时记录两组患者药物引起的肝功能损伤情况。[结果](一)强化他汀组与常规他汀组ACS患者的比较:强化他汀组ACS患者男女比例为65/35,入院时测血肌酐为82.53±23.85,一个月的他汀药物治疗后血肌酐为57.81±15.27;标准剂量他汀组ACS患者男女比例为63/37,入院时测血肌酐为79.48±19.98,一月后血肌酐为63.99±15.35。两组患者治疗后的血肌酐较治疗前均有所下降,差异有统计学意义(P0.05)。且强化组的肌酐值下降较常规组下降明显,差异有统计学意义(P0.05)。(二)强化组与常规组患者肾小球滤过率的比较:强化组患者及常规组患者治疗后肾小球的滤过率均较治疗前有明显改善(P0.05),其中强化组的肾小球滤过率改善较常规组改善明显(P0.05)。(三)强化组与常规组ACS患者实验室检查结果的比较:强化组及常规组ACS患者总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、高敏C反应蛋白(hsCRP)的治疗后较治疗前均有所改善(P0.05)。而强化组患者相比较于常规组患者改善明显(P0.05)。(四)强化组与常规组安全性的比较:治疗过程中,两组患者依从性良好,未发生明显肌痛、肝区不适、大小便性状及次数改变、皮肤瘙痒等不良反应。两组患者均有转氨酶轻度升高者,强化组转氨酶升高者为3人;常规组转氨酶升高者为2人,但均未超过标准值3倍以上。[结论]相比较于标准剂量他汀组,强化他汀组患者可较好的改善患者的肾功能,且在降脂效果更强的情况下,无明显增加不良反应事件。
[Abstract]:[background] coronary heart disease (CHD), especially acute coronary syndrome (acute coronary syndrome, ACS), has become the most important pathophysiological mechanism of the leading killer.ACS, which leads to human death, with the progress of population aging. It is the rupture of atherosclerotic plaque, blood vessel spasm, and the consequent blood. ACS can be divided into non ST segment elevation ACS and ST segment elevation myocardial infarction, which includes unstable angina (unstable angina, UA) and non ST segment elevation myocardial infarction (Non-ST-segment elevation myocardial infarction), according to the changes in ECG in patients with chest pain. In recent years, with the continuous development of ACS interventional therapy and the continuous development and production of therapeutic drugs, the mortality and morbidity of ACS patients are obviously reduced. With the prolongation of the life expectancy of the Chinese people, the incidence of ACS is not only increasing in the elderly population, but also gradually becoming younger. With the number of patients with coronary heart disease, the number of patients with coronary heart disease is gradually increased. More and more attention has been paid to the development of chronic kidney disease in coronary heart disease. The relationship between the two diseases is complicated. The incidence and mortality of coronary heart disease in patients with chronic renal disease have been significantly increased. The incidence of disease, left ventricular hypertrophy, chronic heart failure and stroke also increased significantly. Statins are now widely used in the treatment of CHD patients. He is a 3- hydroxyl -3- methylglutaminic coenzyme A (HMG-Co A) reductase inhibitor, which not only has the effect of lowering blood lipids, inhibiting the synthesis of cholesterol, but also anti-inflammatory, antioxidant stress, and modification. Studies have shown that statins can protect the kidneys by their antioxidation, anti-inflammatory, antithrombotic, protective endothelial cells, induction of angiotensin receptor downregulation, and reduction of endothelin synthesis, and to a certain protective effect on the kidneys. This study is to be compared to short-term intensive dose statins. The effect of ACS patients treated with ACS and standard dose statins on renal function, evaluation of the safety and efficacy of statin therapy on renal function. [Objective] to evaluate statin therapy for renal function by comparing short-term intensive dose statins and standard dose statins. [Methods] 200 cases of acute coronary syndrome in No.1 People's Hospital of Hangzhou in October -2016 March 2013 were selected. The patients were randomly divided into intensive atorvastatin treatment group (40mg) and conventional atorvastatin treatment group (20mg). The hospitalization period of the intensive dose treatment group of atorvastatin. 40mg/N; atrovastatin routine treatment group was hospitalized and discharged with the standard dose of atorvastatin (20mg/N. oral). The blood lipid, liver function, high sensitive C reactive protein (hs-CRP), creatine kinase (CK), serum creatinine level and glomerular filtration rate were measured before and after medication, and two groups were recorded at the same time. [results] [results] (1) the comparison between the intensive statins group and the routine statin group ACS patients: the ratio of men and women with ACS in the statins group was 65/35, the serum creatinine was 82.53 + 23.85 at admission, the serum creatinine was 57.81 + after one month statin therapy, and the ratio of ACS in the standard dose statin group was 63/37, The serum creatinine was 79.48 + 19.98 at admission and the serum creatinine was decreased in 63.99 + 15.35. two groups after one month. The difference was statistically significant (P0.05). The decrease of creatinine in the intensifying group was significantly lower than that in the conventional group (P0.05). (two) glomerular filtration in the intensive and conventional groups Rate comparison: the glomerular filtration rate of the patients in the intensive group and the routine group were significantly improved after the treatment (P0.05). The glomerular filtration rate in the strengthening group was improved significantly compared with the conventional group (P0.05). (three) the comparison of the laboratory results between the intensive group and the routine group of ACS patients: the total cholesterol (TC) in the intensive and conventional group ACS patients (TC ) triglyceride (TG), low density lipoprotein (LDL-C), high density lipoprotein (HDL-C), and Gao Min C reactive protein (hsCRP) were improved after treatment (P0.05). Compared with the conventional group, the patients in the strengthening group were significantly improved (P0.05). (four) compared with the routine group, the two groups were well compliant in the treatment process. No obvious myalgia, discomfort in the liver, changes in the size and number of stool, changes in the number of times, and skin pruritus, and other adverse reactions. The two groups had slightly elevated aminotransferase, 3 in the enhanced group of aminotransferase, 2 in the routine group of transaminase, but not more than 3 times the standard value. [Conclusion] compared to the standard dose statins group, the statins group was strengthened. Patients can improve the renal function of patients better, and there is no obvious increase in adverse reactions when the effect of lipid-lowering is stronger.

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

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