不同剂量瑞舒伐他汀治疗对不稳定型心绞痛患者PCI术后心肌损伤标志物及炎症因子的影响
发布时间：2018-11-21 20:22
【摘要】：目的:通过对拟行择期经皮冠状动脉介入治疗(PCI)的不稳定型心绞痛患者术前给予不同剂量的瑞舒伐他汀,观察其术后心肌损伤标志物的演变,如сTnΙ、СΚ-ΜΒ;与此同时,观测炎症因子—超敏C反应蛋白(hs-CRP)水平变化,来探讨择期PCI患者术前给予不同剂量瑞舒伐他汀治疗对患者的心肌保护作用、炎症因子的影响以及瑞舒伐他汀的安全性问题。方法:选取2015年6月-2016年12月于延安大学东关心脑血管病分院心内科收治的诊断为不稳定型心绞痛并需要拟行择期PCI术的患者80例,随机分为A组(20mg/d)和B组(10mg/d),各组分别收录40例患者;Α组于术前3天开始口服瑞舒伐他汀20mg每日,夜间顿服,术后改为10mg每日长期服用。Β组于术前3天开始口服瑞舒伐他汀钙片10mg/次,每日一次,术后按上述剂量继续服用。每个患者入院后予以采集各个时间段的сTnΙ、СΚ-ΜΒ、hs-CRP水平,分别为术前、PCI术后6h及24h。每个患者于术前、术后15天采血测定TC、TG、LDL-C、HDL-C,同时观察其术后瑞舒伐他汀的副作用及术后1个月心血管不良事件的发生情况。整理所得的数据用SPSS20.0统计包做出进一步统计分析。结果:1.将Α、Β组患者的一般资料进行统计学分析,两组间无统计学差异(P0.05)。2.Α、Β组患者术前血清сTnΙ、СΚ-ΜΒ浓度比较,无统计学差异(P0.05);A、B组患者PCI术后6小时血清сTnΙ、СΚ-ΜΒ浓度升高,但组间比较差异无统计学意义(P0.05)。Β组患者PCI术后24小时血清сTnΙ、СΚ-ΜΒ浓度升高程度相比较于Α组明显,差异有统计学意义(P0.05)。A、B组患者各组内比较,术后6h和24h血清сTnΙ、СΚ-ΜΒ浓度较术前升高,差异有统计学意义(P0.05)。3.Α、Β组患者PCI术前、PCI术后6h血清hs-CRP水平比较,差异无统计学意义(Ρ0.05);术后24h血清hs-CRP水平较入院均升高,Β组较Α组升高明显,差异有统计学意义(Ρ0.05)。A、B组患者各组内比较,术后6h和24h的血清hs-CRP水平较术前升高,差异有统计学意义(P0.05)。4.Α、Β两组患者PCI术后15天血脂各项检验结果比较未见显著性差异。5.A、B两组患者术后出现他汀副作用的情况比较,未见显著性差异。6.所有研究对象术后随访1个月,A、B两组患者ΜΑСЕ事件发生率无统计学差异。结论:1.部分PCI术可导致术后心肌不同程度的损伤,引起一过性cTnI、CK-MB不同程度增高,导致部分病人临床出现心绞痛等症状。2.术前给予20mg瑞舒伐他汀对心肌的保护、炎症因子的抑制作用较10mg瑞舒伐他汀更明显,且近期副作用无明显增加,说明20mg瑞舒伐他汀能更好抑制PCI术后心肌损伤及炎症反应。3.择期PCI术前短期服用瑞舒伐他汀(20mg/d)具有良好的安全性。4.本试验表明择期PCI术前短期服用瑞舒伐他汀(20mg/d)能更好抑制PCI术后心肌损伤和炎症反应,可以在临床上推广使用。
[Abstract]:Objective: to observe the changes of myocardial injury markers in patients with unstable angina pectoris (PCI) undergoing percutaneous coronary intervention (PCI) with different doses of resuvastatin before operation, such as Tn I, 尾-尾; At the same time, the changes of inflammatory factor-hypersensitive C-reactive protein (hs-CRP) levels were observed to investigate the myocardial protective effect of different doses of resuvastatin before selective PCI. Effects of inflammatory factors and safety of resuvastatin. Methods: 80 patients who were diagnosed as unstable angina pectoris from June 2015 to December 2016 in Department of Cardiology and Cerebrovascular Diseases of Dongguan University of Yan'an University and who need elective PCI operation were selected. They were randomly divided into two groups: group A (20mg/d) and group B (10mg/d). The 尾 group began to take resuvastatin 20mg daily at 3 days before operation and was given 10mg daily for a long time after operation. The 尾 group took resuvastatin calcium tablets once a day 3 days before operation, and continued to take it at the same dose after the operation. The levels of Tn I, K- 渭 b and hs-CRP in each time period were collected after admission, which were preoperation, 6h and 24h after PCI, respectively. TC,TG,LDL-C,HDL-C, was measured 15 days before operation and 15 days after operation. The side effects of recuvastatin and the occurrence of cardiovascular adverse events 1 month after operation were also observed. The collected data were further analyzed with SPSS20.0 statistical package. Results: 1. There was no statistical difference between the two groups (P0.05). 2. There was no statistical difference between the two groups (P0.05). In group A, the concentration of Tn I and 尾 in serum increased 6 hours after PCI, but there was no significant difference between the two groups (P0.05). The levels of Tn I and 尾 in serum were significantly higher in group A than in group A at 24 hours after PCI (P0.05). There was significant difference (P0.05). The serum levels of Tn I and 尾 were significantly higher in group A than those in group B at 6 h and 24 h after operation (P0.05) .3APAN, PCI in 尾 group was significantly higher than that in group B (P0.05). There was no significant difference in the level of serum hs-CRP 6 hours after PCI. The serum hs-CRP level was significantly higher in the 尾 group than in the 伪 group at 24 hours after operation, and the difference was statistically significant. The serum hs-CRP level in group A and B was significantly higher than that in the preoperative group at 6 h and 24 h after operation. The difference was statistically significant (P0.05). 4alpha, there was no significant difference in blood lipid test results between two groups of patients 15 days after PCI. 5. The side effects of statins in two groups of patients were compared. There was no significant difference. 6. All subjects were followed up for 1 month. There was no significant difference in the incidence of 渭 伪 events between the two groups. Conclusion: 1. Partial PCI can lead to different degree of myocardial injury after operation, cause transient increase of cTnI,CK-MB in different degrees, and lead to clinical symptoms of angina pectoris in some patients. 2. The protective effect of 20mg before operation on myocardium was more obvious than that of 10mg, and the side effects were not significantly increased in the near future, indicating that 20mg resuvastatin could better inhibit myocardial injury and inflammatory response after PCI. It is safe to take resuvastatin (20mg/d) for a short time before elective PCI. 4. This study suggests that short-term administration of resuvastatin (20mg/d) before elective PCI can better inhibit myocardial injury and inflammation after PCI, and can be popularized in clinic.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
本文编号：2348171
[Abstract]:Objective: to observe the changes of myocardial injury markers in patients with unstable angina pectoris (PCI) undergoing percutaneous coronary intervention (PCI) with different doses of resuvastatin before operation, such as Tn I, 尾-尾; At the same time, the changes of inflammatory factor-hypersensitive C-reactive protein (hs-CRP) levels were observed to investigate the myocardial protective effect of different doses of resuvastatin before selective PCI. Effects of inflammatory factors and safety of resuvastatin. Methods: 80 patients who were diagnosed as unstable angina pectoris from June 2015 to December 2016 in Department of Cardiology and Cerebrovascular Diseases of Dongguan University of Yan'an University and who need elective PCI operation were selected. They were randomly divided into two groups: group A (20mg/d) and group B (10mg/d). The 尾 group began to take resuvastatin 20mg daily at 3 days before operation and was given 10mg daily for a long time after operation. The 尾 group took resuvastatin calcium tablets once a day 3 days before operation, and continued to take it at the same dose after the operation. The levels of Tn I, K- 渭 b and hs-CRP in each time period were collected after admission, which were preoperation, 6h and 24h after PCI, respectively. TC,TG,LDL-C,HDL-C, was measured 15 days before operation and 15 days after operation. The side effects of recuvastatin and the occurrence of cardiovascular adverse events 1 month after operation were also observed. The collected data were further analyzed with SPSS20.0 statistical package. Results: 1. There was no statistical difference between the two groups (P0.05). 2. There was no statistical difference between the two groups (P0.05). In group A, the concentration of Tn I and 尾 in serum increased 6 hours after PCI, but there was no significant difference between the two groups (P0.05). The levels of Tn I and 尾 in serum were significantly higher in group A than in group A at 24 hours after PCI (P0.05). There was significant difference (P0.05). The serum levels of Tn I and 尾 were significantly higher in group A than those in group B at 6 h and 24 h after operation (P0.05) .3APAN, PCI in 尾 group was significantly higher than that in group B (P0.05). There was no significant difference in the level of serum hs-CRP 6 hours after PCI. The serum hs-CRP level was significantly higher in the 尾 group than in the 伪 group at 24 hours after operation, and the difference was statistically significant. The serum hs-CRP level in group A and B was significantly higher than that in the preoperative group at 6 h and 24 h after operation. The difference was statistically significant (P0.05). 4alpha, there was no significant difference in blood lipid test results between two groups of patients 15 days after PCI. 5. The side effects of statins in two groups of patients were compared. There was no significant difference. 6. All subjects were followed up for 1 month. There was no significant difference in the incidence of 渭 伪 events between the two groups. Conclusion: 1. Partial PCI can lead to different degree of myocardial injury after operation, cause transient increase of cTnI,CK-MB in different degrees, and lead to clinical symptoms of angina pectoris in some patients. 2. The protective effect of 20mg before operation on myocardium was more obvious than that of 10mg, and the side effects were not significantly increased in the near future, indicating that 20mg resuvastatin could better inhibit myocardial injury and inflammatory response after PCI. It is safe to take resuvastatin (20mg/d) for a short time before elective PCI. 4. This study suggests that short-term administration of resuvastatin (20mg/d) before elective PCI can better inhibit myocardial injury and inflammation after PCI, and can be popularized in clinic.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.4
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