瑞舒伐他汀强化治疗对行PCI的ACS患者Lp-PLA2和Hs-CRP水平的影响
发布时间：2018-08-03 10:04
【摘要】：目的:探讨阿托伐他汀和不同剂量瑞舒伐他汀治疗对行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的急性冠脉综合征(acute coronary syndrome,ACS)患者围手术期血浆脂蛋白相关磷脂酶A2(lipoprotein-associated phospholipase A2,Lp-PLA2)和血清超敏C反应蛋白(high-sensitivity C-reactive protein,Hs-CRP)水平的影响,观察Lp-PLA2和Hs-CRP水平与ACS患者冠状动脉病变的关系。方法:1入选2016年1月至2016年10月在沧州市中心医院心血管内五科住院治疗,行冠状动脉造影术(coronary angiography,CAG)且PCI的ACS患者90例,其被随机分为三组:1)瑞舒伐他汀常规剂量(10mg)组(n=29):患者入院后常规给予瑞舒伐他汀10mg每晚口服;2)阿托伐他汀常规剂量(20mg)组(n=31):患者入院后常规给予阿托伐他汀20mg每晚口服;3)瑞舒伐他汀强化剂量(20mg)组(n=30):患者入院后常规给予瑞舒伐他汀10mg每晚口服,术前一天至术后三天给予20mg每晚口服,此后改为10mg每晚口服。所有入选的ACS患者入院后详细记录一般临床资料,包括年龄(age)、性别(gender)、身高(height)、体重(weight)、体重指数(body mass index,BMI)、收缩压(systolic blood pressure,SBP)、心率(heart rate,HR)、吸烟史(smoking history)、高血压病史(hypertension history)、血糖(glucose,GLU)、糖尿病病史(diabetes history)、总胆固醇(total cholesterol,TC)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)、甘油三酯(triglyceride,TG)、ACS类型等,比较各组间基线资料参数差异。2根据入选的ACS患者冠状动脉造影检查结果,明确冠状动脉病变情况(病变血管支数、部位以及狭窄程度),利用Gensini积分量化冠状动脉病变程度,并分析血浆脂蛋白相关磷脂酶A2水平、血清超敏C反应蛋白水平与冠状动脉病变程度的相关性。3所有入选的ACS患者分别于术前1天及PCI术后24小时、72小时抽取血样,用于测定血浆Lp-PLA2、血清Hs-CRP等指标水平,比较各组间水平差异。4采用SPSS19.0统计学软件对试验数据进行统计学分析。服从正态分布的计量资料以“均数±标准差”表示,多组间数据比较采用单因素方差分析,P0.05时采用LSD-t检验进行两两比较;不服从正态分布的计量资料以中位数(四分位数间距)表示,多组间数据比较采用非参数Kruskal-Wallis H检验。计数资料以百分比表示,比较采用卡方检验。相关分析中,两变量不均服从正态分布,采用Spearman秩相关分析。以检验水准P0.05具有统计学差异。结果:1三组ACS患者临床基本资料包括年龄、性别、体重指数、收缩压、心率、吸烟史、高血压病史、血糖、糖尿病病史、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、ACS类型等均无统计学差异(P0.05);2三组ACS患者PCI术前,术后24小时、72小时,组间和组内Hs-CRP水平比较,均无统计学差异(P0.05);3三组ACS患者Lp-PLA2水平比较3.1三组ACS患者组间Lp-PLA2水平比较PCI术前,三组Lp-PLA2水平比较无统计学差异(P0.05);PCI术后24小时,三组Lp-PLA2水平比较无统计学差异(P0.05);PCI术后72小时,瑞舒伐他汀常规剂量组与阿托伐他汀常规剂量组Lp-PLA2水平比较,无统计学差异(P0.05);瑞舒伐他汀强化剂量组与瑞舒伐他汀常规剂量组Lp-PLA2水平比较降低,具有统计学差异(P0.05),瑞舒伐他汀强化剂量组与阿托伐他汀常规剂量组Lp-PLA2水平比较降低,具有统计学差异(P0.05);3.2三组ACS患者组内Lp-PLA2水平比较三组ACS患者PCI术后24小时Lp-PLA2水平较术前均升高,具有统计学差异(P0.05);瑞舒伐他汀常规剂量组、阿托伐他汀常规剂量组PCI术后72小时Lp-PLA2水平较术前升高,具有统计学差异(P0.05),瑞舒伐他汀强化剂量组PCI术后72小时Lp-PLA2水平与术前比较,无统计学差异(P0.05);PCI术后72小时,瑞舒伐他汀常规剂量组、阿托伐他汀常规剂量组PCI术后72小时Lp-PLA2水平较术后24小时降低,无统计学差异(P0.05),瑞舒伐他汀强化剂量组PCI术后72小时Lp-PLA2水平较术后24小时降低,具有统计学差异(P0.05);4血浆Lp-PLA2水平与ACS患者冠状动脉病变Gensini积分呈正相关(r=0.355,P=0.001);5 Hs-CRP水平与ACS患者冠状动脉病变Gensini积分零相关(P0.05)。结论:1血浆Lp-PLA2水平较血清Hs-CRP水平更能反映PCI对ACS患者血管造成的损伤、引起的炎症反应以及斑块稳定性的变化情况。2强化剂量瑞舒伐他汀治疗较常规剂量瑞舒伐他汀和常规剂量阿托伐他汀治疗,有更好的抗炎作用。3血浆Lp-PLA2水平与ACS患者冠状动脉病变呈正相关。
[Abstract]:Objective: To explore the perioperative plasma lipoprotein related phospholipase A2 (lipoprotein-associated phospholipase A2,) and blood in patients with acute coronary syndrome (acute coronary syndrome, ACS) treated with atorvastatin and different doses of rosuvastatin in patients with percutaneous coronary intervention (PCI) (acute coronary syndrome, ACS). The relationship between the level of high-sensitivity C-reactive protein (Hs-CRP) and the level of the hypersensitive C reaction protein (Hs-CRP) was observed. Methods: 1 the patients were admitted to the Cangzhou Central Hospital from January 2016 to October 2016, and were hospitalized in the five families of the Cangzhou Central Hospital, and performed coronary angiography (coronary angiography, CAG) and P. 90 patients with ACS of CI were randomly divided into three groups: 1) routine dose of rosuvastatin (10mg) group (n=29): the patients were given routine administration of rosuvastatin 10mg every night after admission; 2) the Atorvastatin routine dose (20mg) group (n=31): the patients were given atorvastatin every night after admission; 3) the intensive dose of rosuvastatin (20mg) group (n=30): The patients were given a routine oral administration of rosuvastatin 10mg every night after admission and were given 20mg every night before the operation, three days after the operation, and then changed to 10mg every night. All the selected ACS patients were enrolled in the general clinical data, including age (age), sex (gender), height (height), weight (weight), body mass index (body mass index, BMI), Systolic blood pressure (systolic blood pressure, SBP), heart rate (heart rate, HR), smoking history (smoking history), hypertension history (hypertension history), blood sugar, diabetes history, total cholesterol, high-density lipoprotein cholesterol, low density fat Low-density lipoprotein cholesterol (LDL-C), triglyceride (triglyceride, TG), ACS type, and so on. Compare the difference of baseline data between each group.2 based on the results of coronary angiography of the selected ACS patients, the coronary artery disease (the number of vessel, the position and the degree of stenosis) was determined by the Gensini integral quantification. The degree of coronary artery disease, and the correlation of plasma lipoprotein related phospholipase A2 level, serum hypersensitivity C reaction protein level and coronary artery disease degree, all selected ACS patients were selected 1 days before and 24 hours after PCI, 72 hours of blood samples, used for measuring plasma Lp-PLA2, serum Hs-CRP and other indicators, compared with each group. The level difference.4 was statistically analyzed by the SPSS19.0 statistical software. The measurement data obeying the normal distribution were expressed as "mean number + standard deviation". The data of multiple groups were compared by single factor analysis of variance, and the LSD-t test was used for 22 comparison in P0.05; the median (four dislocations) that did not obey the normal distribution was in the median. Number spacing) indicated that non parametric Kruskal-Wallis H test was used for data comparison between multiple groups. Counting data was expressed as percentage and chi square test was compared. In correlation analysis, two variables were not all subject to normal distribution and Spearman rank correlation analysis was used to test the level of P0.05 with statistical differences. Results: 1 and three groups of ACS patients' basic clinical data package Age, sex, body mass index, systolic pressure, heart rate, smoking history, hypertension history, blood sugar, diabetes history, total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, ACS type, and so on were not statistically different (P0.05); 2 the three groups of ACS patients were 24 hours, 72 hours after the operation, and the Hs-CRP level in the group and group was compared. There was no statistical difference (P0.05); 3 the level of Lp-PLA2 in three groups of ACS patients was compared with the Lp-PLA2 level of ACS patients in group 3.1. There was no statistical difference between the three groups before PCI (P0.05); 24 hours after PCI, three groups of Lp-PLA2 levels were not statistically different (P0.05); and 72 hours after PCI, the routine dose group of rosuvastatin and Alto The level of Lp-PLA2 in the routine dose group of lovastatin was not statistically significant (P0.05), and the level of Lp-PLA2 in the intensive dose group of rosuvastatin and the routine dose group of rosuvastatin was lower than that of the routine dose group (P0.05). The level of Lp-PLA2 in the intensive dose group of rosuvastatin and the regular dose group of atorvastatin was lower than that of the Atorvastatin group, and there was a statistically significant difference. The level of Lp-PLA2 in 3.2 groups of ACS patients was compared with that of three groups of ACS patients, 24 hours after PCI, the Lp-PLA2 level was higher than that before the operation, with statistical difference (P0.05); the routine dose group of rosuvastatin was higher than that of the routine dose group of atorvastatin 72 hours after PCI operation, and there was a statistically significant difference (P0.05) and strong statins (P0.05). There was no statistical difference (P0.05) at 72 hours after operation at 72 hours after operation in the dose group. 72 hours after PCI, the routine dose group of rosuvastatin, 72 hours after PCI operation in the routine dose group of atorvastatin lower than 24 hours after the operation, there was no statistical difference (P0.05), and 72 hours after PCI operation in the intensive dose group of rosuvastatin was 72 hours Lp-PLA2. The level was lower than 24 hours after the operation (P0.05), and the level of plasma Lp-PLA2 was positively correlated with the Gensini score of coronary artery disease in ACS patients (r=0.355, P=0.001), and the level of 5 Hs-CRP was zero correlation with the Gensini integral of coronary artery disease in ACS patients (P0.05). Conclusion: 1 the Lp-PLA2 level of plasma is better than the level of serum Hs-CRP. Changes in blood vessel damage, inflammatory response and plaque stability.2 enhanced dose of rosuvastatin treatment compared with conventional dose rosuvastatin and routine dose atorvastatin treatment, the better anti inflammatory effect of.3 plasma Lp-PLA2 level was positively correlated with coronary artery disease in ACS patients.
【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
本文编号：2161400
[Abstract]:Objective: To explore the perioperative plasma lipoprotein related phospholipase A2 (lipoprotein-associated phospholipase A2,) and blood in patients with acute coronary syndrome (acute coronary syndrome, ACS) treated with atorvastatin and different doses of rosuvastatin in patients with percutaneous coronary intervention (PCI) (acute coronary syndrome, ACS). The relationship between the level of high-sensitivity C-reactive protein (Hs-CRP) and the level of the hypersensitive C reaction protein (Hs-CRP) was observed. Methods: 1 the patients were admitted to the Cangzhou Central Hospital from January 2016 to October 2016, and were hospitalized in the five families of the Cangzhou Central Hospital, and performed coronary angiography (coronary angiography, CAG) and P. 90 patients with ACS of CI were randomly divided into three groups: 1) routine dose of rosuvastatin (10mg) group (n=29): the patients were given routine administration of rosuvastatin 10mg every night after admission; 2) the Atorvastatin routine dose (20mg) group (n=31): the patients were given atorvastatin every night after admission; 3) the intensive dose of rosuvastatin (20mg) group (n=30): The patients were given a routine oral administration of rosuvastatin 10mg every night after admission and were given 20mg every night before the operation, three days after the operation, and then changed to 10mg every night. All the selected ACS patients were enrolled in the general clinical data, including age (age), sex (gender), height (height), weight (weight), body mass index (body mass index, BMI), Systolic blood pressure (systolic blood pressure, SBP), heart rate (heart rate, HR), smoking history (smoking history), hypertension history (hypertension history), blood sugar, diabetes history, total cholesterol, high-density lipoprotein cholesterol, low density fat Low-density lipoprotein cholesterol (LDL-C), triglyceride (triglyceride, TG), ACS type, and so on. Compare the difference of baseline data between each group.2 based on the results of coronary angiography of the selected ACS patients, the coronary artery disease (the number of vessel, the position and the degree of stenosis) was determined by the Gensini integral quantification. The degree of coronary artery disease, and the correlation of plasma lipoprotein related phospholipase A2 level, serum hypersensitivity C reaction protein level and coronary artery disease degree, all selected ACS patients were selected 1 days before and 24 hours after PCI, 72 hours of blood samples, used for measuring plasma Lp-PLA2, serum Hs-CRP and other indicators, compared with each group. The level difference.4 was statistically analyzed by the SPSS19.0 statistical software. The measurement data obeying the normal distribution were expressed as "mean number + standard deviation". The data of multiple groups were compared by single factor analysis of variance, and the LSD-t test was used for 22 comparison in P0.05; the median (four dislocations) that did not obey the normal distribution was in the median. Number spacing) indicated that non parametric Kruskal-Wallis H test was used for data comparison between multiple groups. Counting data was expressed as percentage and chi square test was compared. In correlation analysis, two variables were not all subject to normal distribution and Spearman rank correlation analysis was used to test the level of P0.05 with statistical differences. Results: 1 and three groups of ACS patients' basic clinical data package Age, sex, body mass index, systolic pressure, heart rate, smoking history, hypertension history, blood sugar, diabetes history, total cholesterol, triglyceride, high density lipoprotein cholesterol, low density lipoprotein cholesterol, ACS type, and so on were not statistically different (P0.05); 2 the three groups of ACS patients were 24 hours, 72 hours after the operation, and the Hs-CRP level in the group and group was compared. There was no statistical difference (P0.05); 3 the level of Lp-PLA2 in three groups of ACS patients was compared with the Lp-PLA2 level of ACS patients in group 3.1. There was no statistical difference between the three groups before PCI (P0.05); 24 hours after PCI, three groups of Lp-PLA2 levels were not statistically different (P0.05); and 72 hours after PCI, the routine dose group of rosuvastatin and Alto The level of Lp-PLA2 in the routine dose group of lovastatin was not statistically significant (P0.05), and the level of Lp-PLA2 in the intensive dose group of rosuvastatin and the routine dose group of rosuvastatin was lower than that of the routine dose group (P0.05). The level of Lp-PLA2 in the intensive dose group of rosuvastatin and the regular dose group of atorvastatin was lower than that of the Atorvastatin group, and there was a statistically significant difference. The level of Lp-PLA2 in 3.2 groups of ACS patients was compared with that of three groups of ACS patients, 24 hours after PCI, the Lp-PLA2 level was higher than that before the operation, with statistical difference (P0.05); the routine dose group of rosuvastatin was higher than that of the routine dose group of atorvastatin 72 hours after PCI operation, and there was a statistically significant difference (P0.05) and strong statins (P0.05). There was no statistical difference (P0.05) at 72 hours after operation at 72 hours after operation in the dose group. 72 hours after PCI, the routine dose group of rosuvastatin, 72 hours after PCI operation in the routine dose group of atorvastatin lower than 24 hours after the operation, there was no statistical difference (P0.05), and 72 hours after PCI operation in the intensive dose group of rosuvastatin was 72 hours Lp-PLA2. The level was lower than 24 hours after the operation (P0.05), and the level of plasma Lp-PLA2 was positively correlated with the Gensini score of coronary artery disease in ACS patients (r=0.355, P=0.001), and the level of 5 Hs-CRP was zero correlation with the Gensini integral of coronary artery disease in ACS patients (P0.05). Conclusion: 1 the Lp-PLA2 level of plasma is better than the level of serum Hs-CRP. Changes in blood vessel damage, inflammatory response and plaque stability.2 enhanced dose of rosuvastatin treatment compared with conventional dose rosuvastatin and routine dose atorvastatin treatment, the better anti inflammatory effect of.3 plasma Lp-PLA2 level was positively correlated with coronary artery disease in ACS patients.
【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
【参考文献】
相关期刊论文 前7条
1 崔旭丹;尹力;袁如玉;崔占前;;血浆脂蛋白相关磷脂酶A2与冠状动脉病变程度及冠状动脉斑块形态的相关分析[J];临床荟萃;2015年12期
2 班茹;夏章勇;霍成举;焦力群;李雪莉;;脂蛋白相关性磷脂酶A2与缺血性脑卒中的相关研究进展[J];中华老年心脑血管病杂志;2015年11期
3 罗艳婷;彭隆;董睿敏;朱洁明;刘金来;;脂蛋白相关磷脂酶A_2水平与冠状动脉病变的关系研究[J];中华临床医师杂志(电子版);2015年09期
4 单瑞;吴尚勤;程爱娟;;围术期强化阿托伐他汀治疗对AMI患者急诊PCI术后Lp-PLA_2及炎症因子的影响[J];天津医药;2015年03期
5 何建新;徐丹苹;;磷脂酶A2及脂蛋白相关磷脂酶A2与动脉粥样硬化相关疾病的研究进展[J];实用医学杂志;2014年07期
6 唐其东;吴平生;李瑜辉;侯玉清;谢佳佳;余天浩;陈武奇;;急性冠状动脉综合征患者脂蛋白相关磷酯酶A2血浆水平及其临床意义[J];中国动脉硬化杂志;2012年09期
7 何晨;唐晓芳;袁晋青;杨跃进;陈纪林;陈珏;尤士杰;吴元;李建军;刘海波;吴永健;姚民;秦学文;戴军;乔树宾;高润霖;;脂蛋白相关磷脂酶A2与冠状动脉病变的关系[J];中国循环杂志;2011年05期
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