不同剂量瑞舒伐他汀治疗对急性冠脉综合征患者PCI术后PTX3、NT-proBNP浓度的影响

发布时间：2018-05-01 22:30

本文选题：瑞舒伐他汀 + 经皮冠状动脉介入治疗　；参考：《河北医科大学》2015年硕士论文

【摘要】：目的:本研究通过比较不同剂量的瑞舒伐他汀(Rosuvastatin,Rosu)对择期行经皮冠状动脉成形术(percutaneous coronary intervention,PCI)的急性冠脉综合征(acute coronary syndrome,ACS)患者治疗疗效,探讨瑞舒伐他汀减少ACS患者围PCI期心肌损伤发生情况的机制及术后30天的临床疗效,为择期行PCI术ACS患者应用他汀类药物提供客观依据。方法:本研究入选60例ACS并择期行PCI术患者,依据随机数字表法随机分为3组。瑞舒伐他汀低剂量治疗组(20例,5mg/qn,至少口服1月);瑞舒伐他汀常规剂量治疗组(20例,10mg/qn,至少口服1月);瑞舒伐他汀强化剂量治疗组(20例,20mg/qn,至少口服1月)。所有入选患者入院后详细记录临床资料,包括姓名、性别、年龄、高血压史、糖尿病史、个人吸烟史、家族史、三大常规、血糖、血脂(总胆固醇TC、甘油三酯TG、低密度脂蛋白LDL-C、高密度脂蛋白HLD-C)、肝功能、肾功能、CK-MB、hs-c Tn I、NT-pro BNP、PTX3、处理血管数量等相关数据。观察指标:(1)三组患者PCI术前、术后24h CK-MB(creatine kinase-MB,CK-MB)、hs-c Tn I(cardiac troponin I,c Tn I)水平变化;(2)三组患者PCI术前、术后3天、术后30天血浆PTX3(pentraxin 3,PTX3)、NT-pro BNP(N-terminal pro-brain natriuretic peptide,NT-pro BNP)水平变化;(3)三组患者PCI术后30天内主要不良心血管事件(major adverse cardiac events,MACE)包括心脏死亡、心肌梗死、再次血运重建、心衰、反复心绞痛。(4)三组患者药物不良反应发生情况。结果:1三组患者入院后的临床基本资料,包括年龄、性别、高血压史、糖尿病史、吸烟史、TC、TG、LDL-C、HDL-C、CK-MB、hs-c Tn I、PTX3、NT-pro BNP、血管紧张素转换酶抑制剂(ACEI)/血管紧张素受体拮抗剂(ARB)、β受体阻滞剂、阿司匹林、氯吡格雷的应用等均无统计学差异(P0.05)。2以hs-c Tn I和CK-MB作为心肌损伤标记物 2.1三组患者PCI术后24小时hs-c Tn I水平均较术前升高,差异有统计学意义(P0.05)。强化剂量组升高幅度明显低于低剂量组、常规剂量组,常规剂量组升高幅度低于低剂量组,差异有统计学意义(P0.05)。2.2三组患者PCI术后24小时CK-MB水平均较术前升高,差异有统计学意义(P0.05)。强化剂量组升高幅度明显低于低剂量组、常规剂量组,常规剂量组升高幅度低于低剂量组,差异有统计学意义(P0.05)。3三组患者PCI术后3天、30天NT-pro BNP水平变化3.1三组患者术后3天NT-pro BNP水平较术前升高,差异有统计学意义(P0.05)。低剂量组、常规剂量组、强化剂量组之间进行比较,均略有升高,差异无统计学意义(P0.05)。3.2三组患者术后30天NT-pro BNP水平较术前降低,差异有统计学意义(P0.05)。低剂量组、常规剂量组、强化剂量组之间进行比较,均略有降低,差异无统计学意义(P0.05)。4三组患者PCI术后3天、30天PTX3水平变化4.1三组患者术后3天PTX3水平较术前升高,差异无统计学意义(P0.05)。低剂量组、常规剂量组、强化剂量组之间进行比较,均略有升高,差异无统计学意义(P0.05)。4.2三组患者术后30天PTX3水平较术前降低,差异无统计学意义(P0.05)。低剂量组、常规剂量组、强化剂量组之间进行比较,均略有降低,差异无统计学意义(P0.05)。5三组患者PCI术后30天内MACE发生情况,差异无统计学意义(P0.05)。6三组患者药物不良反应发生情况,差异无统计学意义(P0.05)。结论:1瑞舒伐他汀强化剂量治疗在ACS患者择期PCI术围手术期心肌保护作用上优于低剂量治疗和常规剂量治疗。2瑞舒伐他汀能够降低ACS患者PCI术后30天NT-pro BNP水平,但不同剂量组之间无统计学差异。3瑞舒伐他汀能够降低ACS患者PCI术后30天PTX3水平,但不同剂量组之间、不同时间段之间无统计学差异。4三组患者PCI术后30天MACE发生率无统计学差异。 5三组患者均未发生药物不良反应。
[Abstract]:Objective: To investigate the effects of different doses of Rosuvastatin (Rosu) on acute coronary syndrome (acute coronary syndrome, ACS) in patients undergoing selective percutaneous coronary angioplasty (percutaneous coronary intervention, PCI), and to explore the effect of rosuvastatin on the incidence of myocardial injury in ACS patients. The mechanism and the clinical efficacy of 30 days postoperatively provide an objective basis for the use of statins for PCI ACS patients undergoing elective operation. Methods: This study was selected for 60 cases of ACS and selected for PCI surgery, and randomly divided into 3 groups according to the random digital table method. The low dose treatment group of rosuvastatin (20 cases, 5mg /qn, at least oral January); routine dose treatment of rosuvastatin. Treatment group (20 cases, 10mg/qn, at least oral January); rosuvastatin intensive dose treatment group (20 cases, 20mg/qn, at least orally for January). All selected patients were enrolled in detailed clinical records, including name, sex, age, hypertension, diabetes history, personal history of smoking, family history, three routine, blood glucose, triglyceride TG, low level of triglyceride (triglyceride TG, low) Density lipoprotein LDL-C, high density lipoprotein HLD-C), liver function, renal function, CK-MB, HS-C Tn I, NT-pro BNP, PTX3, and the number of vessels dealing with blood vessels. (1) three groups of patients before and after operation 24h CK-MB (2) three groups of patients before, 3 days after surgery, 30 days after the operation, plasma PTX3 (pentraxin 3, PTX3), NT-pro BNP (N-terminal pro-brain natriuretic peptide, NT-pro BNP) level changes; (3) the three group of patients within 30 days after 30 days of cardiac death, myocardial infarction, re reconstruction of blood, heart failure, recurrent angina. (4) three groups of patients (4) Results: 1. Results: 1 the basic clinical data of the three groups were: age, sex, hypertension, diabetes, smoking history, TC, TG, LDL-C, HDL-C, CK-MB, HS-C Tn I, PTX3, NT-pro BNP, angiotensin converting enzyme inhibitors (ACEI) / angiotensin receptor antagonists, beta blockers, aspirin, chlorine There was no statistically significant difference in the application of pyridine Gray (P0.05).2 with HS-C Tn I and CK-MB as a marker of myocardial injury 2.1. The level of HS-C Tn I in 24 hours after PCI was higher than that before the operation. The difference was statistically significant (P0.05). The increase in the dose group was significantly lower than that in the low dose group. The routine dose group was lower than the conventional dose group. In the low dose group, the difference was statistically significant (P0.05) in group.2.2 three, the level of CK-MB was higher at 24 hours after PCI, and the difference was statistically significant (P0.05). The increase in the intensive dose group was significantly lower than that in the low dose group. The routine dose group was lower than the low dose group, and the difference was statistically significant (P0.05) P of the.3 three groups. 3 days after CI, 30 days NT-pro BNP level changes in 3.1 three patients, 3 days after the operation, NT-pro BNP level was higher than before the operation, the difference was statistically significant (P0.05). Low dose group, routine dose group, enhanced dose group comparison, the difference was slightly higher, the difference was not statistically significant (P0.05).3.2 three after 30 days NT-pro BNP level was lower than before the operation, The difference was statistically significant (P0.05). The comparison between the low dose group, the routine dose group and the intensive dose group decreased slightly. The difference was not statistically significant (P0.05) in the group.4 three, 3 days after PCI, and the 30 day PTX3 level in 4.1 three groups, the PTX3 level was higher than that before the operation, the difference was not statistically significant (P0.05). The low dose group and the conventional dose were not significant. Group, compared with the intensive dose group, the difference was slightly higher, the difference was not statistically significant (P0.05), the level of PTX3 in group.4.2 three was lower than before operation, the difference was not statistically significant (P0.05). The low dose group, the routine dose group, and the contrast between the intensive dose groups were slightly lower, the difference was not statistically significant (P0.05).5 three patients PCI The incidence of MACE within 30 days after operation was not statistically significant (P0.05) and there was no significant difference in the occurrence of adverse drug reactions in the group.6 three patients (P0.05). Conclusion: 1 the enhanced dose therapy of rosuvastatin is superior to low dose and routine dose treatment of.2 resuvastatin in the perioperative myocardial protection of ACS patients undergoing selective PCI surgery. Enough to reduce the level of NT-pro BNP at 30 days after PCI operation in ACS patients, but there was no statistical difference between different dosage groups,.3 could reduce the PTX3 level of ACS patients at 30 days after PCI operation, but there was no statistical difference between different doses groups, and there was no statistical difference between the 30 days after PCI operation in the group of.4 three groups. The 5 three groups were not different. There is a drug adverse reaction.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R541.4

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