依折麦布对非ST段抬高型心肌梗死患者血脂、炎症因子及短期预后的影响

发布时间：2018-02-12 13:25

本文关键词： 依折麦布非ST段抬高型心肌梗死血脂炎症因子短期预后　出处：《昆明医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：[目的]通过本研究,研讨依折麦布对非ST段抬高型心肌梗死(NSTEMI)患者血脂水平、炎症因子及短期预后的影响,以便为临床治疗方案提供参考。[方法]收集2016年1月至2016年9月于我院住院治疗患者的临床资料,根据制定的纳入及排除标准再次筛选符合条件的病人,共计70例,将70例NSTEMI患者入院后立即随机分为依折麦布(益适纯,10mg/qd)联合阿托伐他汀(立普妥,20mg/qn)治疗组,即实验组,共32例;单用阿托伐他汀治疗组(20mg/qn),即对照组,共38例。统计所有入组病人的性别、年龄、高血压史、糖尿病史、吸烟史,治疗前高敏C反应蛋白(hs-CRP)、白介素-6(IL-6)、降钙素原(PCT)、总胆固醇(TC)、低密度脂蛋白(LDL-C)、甘油三酯(TG)、脑利钠肽(BNP)、左室舒张末期内径(LVEDD)、左室收缩末内径(LVESD)、左室射血分数(LVEF)。所有入组患者于出院后随访,随访时间为6个月;随访内容包括hs-CRP、IL-6、PCT、LDL-C、TG、TC、BNP、LVEDD、LVESD、LVEF,治疗期间药物不良反应,治疗6个月后主要心脏不良事件(MACE,心源性死亡、再次心肌梗死、再发心绞痛、继发心衰和脑卒中)发生率等相关数据。采用SPSS19.0统计包分析数据资料,以P0.05判断为差异有统计学意义。[结果]两组患者间在人口统计特征及基本临床资料上无明显差异;(1)治疗前实验组及对照组患者TC、LDL-C及TG基线水平差异无统计学意义(P0.05):治疗6个月后随访:两组患者LDL-C及TC水平均降低,且实验组较治疗组LDL-C、TC水平降低更加明显,两组间比较差异有统计学意义(分别为P0.05和P0.01),治疗后实验组血脂达标率较对照组更高,两组间比较差异有统计学意义(P0.01);而治疗后实验组及对照组患者甘油三脂(TG)无明显降低,两组间比较差异无统计学意义(P0.05)。(2)治疗前实验组及对照组患者BNP、hs-CRP、IL-6及PCT差异无统计学意义(P0.05);治疗6个月后两组患者BNP、hs-CRP、IL-6及PCT均降低,与对照组相比,实验组患者hs-CRP、IL-6、PCT降低更加明显,两组间比较差异有统计学意义(分别为P0.05,P0.01和P0.01),而治疗后BNP两组间比较差异无统计学意义(P0.05)。(3)实验组及对照组无肝酶升高、CK升高、肌酐升高、肌痛、过敏反应等不良反应退出实验。(4)实验组及对照组治疗6个月后MACE的发生率比较差异无统计学意义(P0.05)。(5)治疗前实验组及对照组患者LVEDD、LVESD、LVEF差异无统计学意义(P0.05);治疗6个月后两组患者的LVEDD、LVESD、LVEF均无明显改善,且两组间比较差异无统计学意义(P0.05)。[结论]阿托伐他汀可以有效降低患者TC、LDL-C、BNP、hs-CRP、IL-6及PCT水平;在阿托伐他汀的基础上联合依折麦布可进一步降低TC、LDL-C,hs-CRP、IL-6及PCT水平,提高血脂的达标率;联合用药对NSTEMI患者的短期预后尚无明显改善。
[Abstract]:[objective] to study the effects of Ezeimib on blood lipid levels, inflammatory factors and short-term prognosis in patients with non-ST-segment elevation myocardial infarction (NSTEMI). In order to provide reference for clinical treatment scheme. [methods] the clinical data of inpatients in our hospital from January 2016 to September 2016 were collected. According to the criteria of inclusion and exclusion, 70 eligible patients were re-screened. Immediately after admission, 70 patients with NSTEMI were randomly divided into two groups: the treatment group of Ezeimet (10 mg / QD) and the treatment group of 20 mg / QN of Lipitor, the experimental group (32 cases), and the group treated with Atto vastatin (20 mg / qng), that is, the control group. Gender, age, history of hypertension, history of diabetes, history of smoking, Before treatment, Gao Min C-reactive protein hs-CRPU, interleukin-6 siloxacin IL-6, procalcitonin protopril, total cholesterol TCU, low density lipoprotein (LDL-C), triglyceride (TGN), brain natriuretic peptide (BNPN), left ventricular end-diastolic diameter (LVEDDD), left ventricular end-systolic dimension (LVESDD), left ventricular ejection fraction (LVEF), and left ventricular ejection fraction (LVEF). The patients were followed up after discharge. The follow-up period was 6 months. The follow-up included hs-CRP IL-6, PCT, LDL-Con, TGN, TGN, LVEDDD, LVESD-LVEF, adverse drug reactions during the treatment period, major adverse cardiac events such as MACEE, cardiogenic death, secondary myocardial infarction and recurrent angina pectoris after 6 months of treatment. SPSS19.0 statistical package was used to analyze the data. [results] there was no significant difference in the demographic characteristics and basic clinical data between the two groups. [results] there was no significant difference in the baseline level of TCU LDL-C and TG between the experimental group and the control group before treatment. P0.05: follow up after 6 months: the levels of LDL-C and TC decreased in both groups. The LDL-CU TC level in the experimental group was significantly lower than that in the treatment group, and the difference between the two groups was statistically significant (P0.05 and P0.01, respectively). After treatment, the blood lipids reached the standard rate in the experimental group was higher than that in the control group. The difference between the two groups was statistically significant (P 0.01), but there was no significant decrease in triglyceride TG after treatment in the experimental group and the control group. There was no significant difference in BNPhs-CRPnIL-6 and PCT between the two groups before and after treatment, but after 6 months of treatment, the levels of BNPhs-CRPU IL-6 and PCT in the two groups were lower than those in the control group, and the hs-CRPIL-6PCT in the experimental group was significantly lower than that in the control group. There were significant differences between the two groups (P0.05, P0.01 and P0.01, respectively, but there was no significant difference between the two groups after treatment.) there was no increase in CK, creatinine and myalgia in the experimental group and the control group. After 6 months of treatment, there was no significant difference in the incidence of MACE between the experimental group and the control group. (P0.05) before treatment, there was no significant difference in LVEDDD, LVESDSD, LVEF in the experimental group and control group, and in the 6 months of treatment, there was no significant difference in the incidence of MACE in the experimental group and the control group, and in the treatment of 6 months, there was no significant difference in the incidence of MACE. There was no significant improvement in LVEF of LVEDDV LVESDN in the latter two groups. There was no significant difference between the two groups (P 0.05). [conclusion] Atto vastatin can effectively reduce the levels of IL-6 and PCT in patients with TCU LDL-CnBNPHs-CRPU, and combine with Ezeimebumin on the basis of Atto statin can further decrease the levels of TCL-Chs-CRPIL-6 and PCT, and increase the blood lipid compliance rate. The short-term prognosis of patients with NSTEMI was not significantly improved by combined use of drugs.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22

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