雷公藤多苷对PCI患者冠脉支架内再狭窄发生率及远期预后的影响

发布时间：2018-05-25 20:20

本文选题：雷公藤多苷 + 冠心病　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:探讨雷公藤多苷对冠心病PCI患者术后冠脉支架内再狭窄发生率和远期预后的影响。方法:将2015年06月到2015年12月期间在青岛大学医学院附属医院及高密市人民医院心内科住院接受经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的患者随机入组。其中对照组79例,年龄30-89岁,其中男性56例,女性23例。行PCI治疗后常规给予阿司匹林+氢氯吡格雷双联抗血小板、他汀类调脂、稳定斑块、控制血糖、血压等治疗。观察组79例,年龄30-89岁,其中男性61例,女性18例。在对照组治疗方案基础上于术后24小时内加用雷公藤多苷片按1mg/(kg·d),每天分三次服用2个月,在每次口服剂量不变情况下改为每天两次服用2个月,最后改为每天一次服用2个月。两组患者每月一次复查,统计所有病例的一般资料,包括甘油三酯(TG),低密度脂蛋白(LDL),总胆固醇(Tcho),糖化血红蛋白(HBa1c),射血分数(EF),收缩压(Sbp),舒张压(Dbp),脉搏(p),血常规及肝肾功,随访1年,了解患者主要心脏不良事件(major adverse cardiac events,MACE)情况(死亡、非致死性心肌梗死和靶血管血运重建)。应用COX多因素分析比较观察组和对照组在校正了其他变量时MACE发生率差异是否存在统计学意义。结果:观察组患者在服用雷公藤多苷片2个月后有6例出现胃肠道不适症状,有3例患者出现白细胞下降,有9例出现谷丙转氨酶(ALT)升高,在药物减量及停药后即好转。分析结果显示,两组患者在年龄、性别构成、心率、血压、左室射血分数、病变部位、病变类型等方面差异无统计学意义(P0.05)。在前4个月的时间里在总胆固醇、低密度脂蛋白、谷丙转氨酶等方面表现出了统计学差异(P0.05),而这种差异在1年后消失,在一年后的随访中,在所有入组的158名患者当中,发生MACE事件的有15例,MACE事件的发生率为9.80%,其中观察组有3例,对照组有12例,总胆固醇、低密度脂蛋白、谷丙转氨酶差异具有统计学意义(P0.05)。观察组MACE发生率3.7%(3例),其中死亡1例,血运重建2例;对照组MACE发生率10.1%(12例),其中血运重建9例;非致死性心肌梗死3例。两组患者在1年后MACE事件发生率有统计学差异(P0.05),将所有患者基线资料进行COX单因素分析显示,低密度脂蛋白、总胆固醇、收缩压对MACE事件发生率的影响具有统计学意义,将分组、低密度脂蛋白、总胆固醇、收缩压纳入COX多因素分析显示,在校正了其他变量后,观察组和对照组患者MACE发生率差具有统计学意义(P=0.0413,HR=0.808,CI95%=0.259-2.517)。结论:1.应用雷公藤多苷会在短期内降低患者的白细胞,升高患者的谷丙转氨酶,停药后会逐渐消退。2.雷公藤多苷显示出可以减少PCI患者术后MACE事件的发生率。3.雷公藤多苷显示出具有降低PCI术后冠脉支架再狭窄的发生率的趋势,但差异不具有统计学意义(P0.05)。
[Abstract]:Objective: to investigate the effect of tripterygium wilfordii polyglycosides on the incidence and long-term prognosis of coronary stent restenosis in patients with coronary heart disease (PCI). Methods: from June 2015 to December 2015, patients who were hospitalized in Department of Cardiology, affiliated Hospital of Medical College of Qingdao University and Department of Cardiology, Gaomi City people's Hospital, received percutaneous coronary intervention therapy (coronary interventionn). There were 79 cases in the control group, aged 30-89 years, including 56 males and 23 females. After PCI treatment, aspirin hydroclopidogrel dual antiplatelet therapy, statin lipid regulation, plaque stabilization, blood glucose control, blood pressure, and so on. There were 79 cases in the observation group, aged 30-89 years, including 61 males and 18 females. On the basis of the treatment plan of the control group, tripterygium wilfordii polyglycoside tablet was added within 24 hours after operation according to 1mg/(kg dai, divided into 3 times a day for 2 months, then taken twice a day for 2 months at the same oral dose per day, and then changed to once a day for 2 months at last. The patients in the two groups were reviewed once a month. The general data of all patients were analyzed, including triglyceride, low density lipoprotein (LDLN), total cholesterol, HBa1cn, ejection fraction (EFF), systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse, blood routine, and liver and kidney function. The patients were followed up for 1 year to find out the major adverse cardiac events (death, non-fatal myocardial infarction and target vessel revascularization). COX multivariate analysis was used to compare whether there was significant difference in the incidence of MACE between the observation group and the control group when the other variables were adjusted. Results: after taking tripterygium wilfordii polyglycosides for 2 months, there were 6 cases of gastrointestinal discomfort, 3 cases of leukopenia and 9 cases of elevated alanine aminotransferase (alt). The results showed that there were no significant differences in age, sex composition, heart rate, blood pressure, left ventricular ejection fraction (LVEF), lesion location and pathological type between the two groups (P 0.05). During the first four months, there was a statistically significant difference in total cholesterol, low density lipoprotein, alanine aminotransferase, and so on, which disappeared after one year and was followed up one year later among all 158 patients who entered the group. The incidence of Mace in 15 patients with MACE was 9.80. There were 3 cases in the observation group and 12 cases in the control group. There were significant differences in total cholesterol, low density lipoprotein and alanine aminotransferase between the two groups (P 0.05). The incidence of MACE in the observation group was 3.7%, including death in 1 case and revascularization in 2 cases, in the control group, the incidence of MACE was 10.1 in 12 cases, including 9 cases of revascularization, and 3 cases of non-fatal myocardial infarction. There was a significant difference in the incidence of MACE events between the two groups after one year. The baseline data of all patients were analyzed by COX univariate analysis. The effects of low density lipoprotein (LDL), total cholesterol (TC) and systolic blood pressure (SBP) on the incidence of MACE events were statistically significant. COX multivariate analysis showed that after adjusting for other variables, the incidence of MACE in the observation group and the control group was significantly lower than that in the control group. There was a significant difference in the incidence of MACE between the observation group and the control group. The incidence of MACE was 0.808% CI 9595 and 0.259-2.517% after adjusting for the other variables in the group of low density lipoprotein (LDL), total cholesterol and systolic blood pressure (SBP). Conclusion 1. Tripterygium wilfordii polyglycosides can reduce the leukocyte in patients in a short period of time, increase the alanine aminotransferase in patients, and gradually fade. 2. Tripterygium wilfordii polyglycosides have been shown to reduce the incidence of MACE events in patients with PCI. Tripterygium wilfordii showed a tendency to reduce the incidence of coronary stent restenosis after PCI, but the difference was not statistically significant (P 0.05).
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4

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