氯吡格雷或阿托伐他汀强化治疗对老年心肌梗死疗效的影响
发布时间：2018-12-15 07:13
【摘要】：目的急性心肌梗死(acute myocardial infarction,AMI)是冠心病的最严重类型,是临床上导致心源性猝死的主要病因,患者临床上通常表现为胸闷、心律失常、休克甚至心衰。本课题旨在分析氯吡格雷强化或阿托伐他汀强化治疗对老年急性心肌梗死的不同治疗效果和MACE事件发生率的变化以及药物临床副作用的观察研究,并探讨治疗过程中相关的炎症反应因子、氧化-抗氧化蛋白、内皮生长因子和转化生长因子水平变化,进而为临床治疗提供参考。方法分析本院2009年1月至2015年10月期间诊治的老年急性心肌梗死患者临床资料。300例患者中男180例,女120例,年龄66-78岁,平均72.9±5.1岁。所有患者均符合中华医学会心血管分会在2015年制定的《急性ST段抬高心肌梗死诊断和治疗指南》中关于急性心肌梗死的诊断标准。所有病人都给予符合急性心肌梗死指南的治疗(即阿司匹林、阿托伐他汀、氯吡格雷,低分子肝素β受体阻滞剂,ACEI类药物等)均接受PCI治疗。实验观察时间为一个月,标准治疗组人数为115人,剂量:阿司匹林100mg,氯吡格雷75mg,阿托伐他汀20mg;氯吡格雷强化组人数为95人,剂量:阿司匹林100mg,氯吡格雷150mg,阿托伐他汀20mg;阿托伐他汀强化组人数为90人,剂量:阿司匹林100mg,氯吡格雷75mg,阿托伐他汀40mg。各组按研究方案完成治疗后,对各组患者的临床治疗进行MACE分析和临床副作用的观察比较以及治疗前后血清中炎症反应因子、氧化-抗氧化酶及VEGF和TGFβ蛋白水平变化。结果1.同标准治疗组相比,阿托伐他汀强化组与氯吡格雷强化组的MACE事件发生率明显降低(P0.05);而阿托伐他汀强化组同氯吡格雷强化组的MACE事件发生率无统计学意义(P0.05)。2.与标准治疗组相比,阿托伐他汀强化组与氯吡格雷强化组患者合并出血、胃肠道反应、粒细胞减少、肌病、肝酶异常等副作用无显著统计学差异(P0.05)。3.与标准治疗组和氯吡格雷强化组相比,阿托伐他汀强化组老年急性心肌梗死患者血清中反应性炎症因子水平均有明显的抑制作用且差异存在显著统计学意义(P0.05);而比较标准治疗组和氯吡格雷强化组,两组间无明显统计学差异(P0.05)。4.与标准治疗组患者相比,MDA水平在氯吡格雷强化组和阿托伐他汀强化组患者血清中被显著抑制;而SOD、CAT和GSHPX等蛋白在氯吡格雷强化组和阿托伐他汀强化组组中则明显高表达,且差异均存在显著统计学意义(P0.05)。5.与标准治疗组相比,氯吡格雷强化组和阿托伐他汀强化组患者血清中TGF-β及VEGF蛋白表达有明显的抑制作用,且差异存在显著统计学意义(P0.05),结论氯吡格雷或阿托伐他汀强化治疗对老年急性心肌梗死患者可产生保护性的治疗效果且不良反应发生率无明显升高,其药理机制可能与调节患者病变血管的炎症反应和氧化-抗氧化水平状态有关。
[Abstract]:Objective Acute Myocardial Infarction (acute myocardial infarction,AMI) is the most serious type of coronary heart disease and is the main cause of sudden cardiac death. The clinical manifestations of patients are chest tightness arrhythmia shock and even heart failure. The purpose of this study was to analyze the effects of clopidogrel intensification or Atto vastatin intensive therapy on elderly patients with acute myocardial infarction (AMI) and the changes of MACE events and the clinical side effects of drugs. The changes of inflammatory response factor, oxidation-antioxidation protein, endothelial growth factor and transforming growth factor in the course of treatment were also discussed in order to provide reference for clinical treatment. Methods the clinical data of 300 elderly patients with acute myocardial infarction (AMI) from January 2009 to October 2015 were analyzed. There were 180 males and 120 females, aged from 66 to 78 years, with an average age of 72.9 卤5.1 years. All the patients were in accordance with the diagnostic criteria for acute ST segment elevation myocardial infarction (AMI) developed by the Chinese Medical Association Cardiovascular Society in 2015. All patients were treated with PCI (aspirin, Atto statins, clopidogrel, low molecular weight heparin 尾 receptor blockers, ACEI drugs, etc.) in accordance with the guidelines for acute myocardial infarction. The experimental observation time was one month, the standard treatment group was 115 people, the dosage of aspirin was 100 mg, clopidogrel 75 mg, Atto vastatin 20 mg; The dosage of clopidogrel was 100 mg aspirin, 150 mg clopidogrel, 20 mg Atto vastatin and 90 cases Atto vastatin plus aspirin 100 mg, clopidogrel 75 mg, Atto vastatin 40 mg. After the treatment was completed according to the study plan, the MACE analysis and the clinical side effects were observed and compared. The levels of serum inflammatory response factor, oxidation-antioxidant enzyme, VEGF and TGF 尾 protein were compared before and after the treatment. Result 1. Compared with the standard treatment group, the incidence of MACE events in the Atto vastatin group and clopidogrel group was significantly lower (P0.05). However, there was no significant difference in the incidence of MACE events between the Atto and clopidogrel groups (P0.05). Compared with the standard treatment group, there was no significant difference in side effects such as hemorrhage, gastrointestinal reaction, granulocytopenia, myopathy and liver enzyme abnormality between Atto and clopidogrel groups (P0.05). Compared with the standard treatment group and clopidogrel group, the serum levels of reactive inflammatory factors in the elderly patients with acute myocardial infarction were significantly inhibited by Atto vastatin (P0.05). The standard treatment group and clopidogrel reinforcement group, there was no significant difference between the two groups (P0.05). Compared with the standard treatment group, MDA levels were significantly inhibited in clopidogrel group and Atto vastatin group. The expression of SOD,CAT and GSHPX was significantly higher in clopidogrel group and Atto vastatin group, and the difference was statistically significant (P0.05). Compared with the standard treatment group, the expression of TGF- 尾 and VEGF protein in serum of clopidogrel group and Atto vastatin group were significantly inhibited, and the difference was statistically significant (P0.05). Conclusion intensive therapy with clopidogrel or Atto vastatin has protective effect on elderly patients with acute myocardial infarction and the incidence of adverse reactions is not significantly increased. Its pharmacological mechanism may be related to the regulation of inflammatory response and oxidation-antioxidation state of the diseased vessels.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22
本文编号：2380222
[Abstract]:Objective Acute Myocardial Infarction (acute myocardial infarction,AMI) is the most serious type of coronary heart disease and is the main cause of sudden cardiac death. The clinical manifestations of patients are chest tightness arrhythmia shock and even heart failure. The purpose of this study was to analyze the effects of clopidogrel intensification or Atto vastatin intensive therapy on elderly patients with acute myocardial infarction (AMI) and the changes of MACE events and the clinical side effects of drugs. The changes of inflammatory response factor, oxidation-antioxidation protein, endothelial growth factor and transforming growth factor in the course of treatment were also discussed in order to provide reference for clinical treatment. Methods the clinical data of 300 elderly patients with acute myocardial infarction (AMI) from January 2009 to October 2015 were analyzed. There were 180 males and 120 females, aged from 66 to 78 years, with an average age of 72.9 卤5.1 years. All the patients were in accordance with the diagnostic criteria for acute ST segment elevation myocardial infarction (AMI) developed by the Chinese Medical Association Cardiovascular Society in 2015. All patients were treated with PCI (aspirin, Atto statins, clopidogrel, low molecular weight heparin 尾 receptor blockers, ACEI drugs, etc.) in accordance with the guidelines for acute myocardial infarction. The experimental observation time was one month, the standard treatment group was 115 people, the dosage of aspirin was 100 mg, clopidogrel 75 mg, Atto vastatin 20 mg; The dosage of clopidogrel was 100 mg aspirin, 150 mg clopidogrel, 20 mg Atto vastatin and 90 cases Atto vastatin plus aspirin 100 mg, clopidogrel 75 mg, Atto vastatin 40 mg. After the treatment was completed according to the study plan, the MACE analysis and the clinical side effects were observed and compared. The levels of serum inflammatory response factor, oxidation-antioxidant enzyme, VEGF and TGF 尾 protein were compared before and after the treatment. Result 1. Compared with the standard treatment group, the incidence of MACE events in the Atto vastatin group and clopidogrel group was significantly lower (P0.05). However, there was no significant difference in the incidence of MACE events between the Atto and clopidogrel groups (P0.05). Compared with the standard treatment group, there was no significant difference in side effects such as hemorrhage, gastrointestinal reaction, granulocytopenia, myopathy and liver enzyme abnormality between Atto and clopidogrel groups (P0.05). Compared with the standard treatment group and clopidogrel group, the serum levels of reactive inflammatory factors in the elderly patients with acute myocardial infarction were significantly inhibited by Atto vastatin (P0.05). The standard treatment group and clopidogrel reinforcement group, there was no significant difference between the two groups (P0.05). Compared with the standard treatment group, MDA levels were significantly inhibited in clopidogrel group and Atto vastatin group. The expression of SOD,CAT and GSHPX was significantly higher in clopidogrel group and Atto vastatin group, and the difference was statistically significant (P0.05). Compared with the standard treatment group, the expression of TGF- 尾 and VEGF protein in serum of clopidogrel group and Atto vastatin group were significantly inhibited, and the difference was statistically significant (P0.05). Conclusion intensive therapy with clopidogrel or Atto vastatin has protective effect on elderly patients with acute myocardial infarction and the incidence of adverse reactions is not significantly increased. Its pharmacological mechanism may be related to the regulation of inflammatory response and oxidation-antioxidation state of the diseased vessels.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R542.22
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