强化他汀治疗在急性冠脉综合症患者急诊PCI术中相关因素分析
发布时间：2019-04-28 07:59
【摘要】：目的:本实验通过研究急诊PCI术前给予强化他汀药物治疗对急性冠脉综合症患者外周循环血液中内皮微粒(EMPs)和(或)高敏C反应蛋白(hs-CRP)水平的影响,来讨论强化他汀抑制患者内皮细胞的炎症反应以及观察术后患者强化他汀治疗的安全性和短期内心血管不良事件的发生。方法:选取延安大学附属医院心内科住院期间行急诊PCI术的ACS患者100例,按随机方法分为两组,强化组:患者50例,急诊PCI术前顿服阿托伐他汀钙4片(80mg),术后坚持服用3个月(40mg);常规组:患者50例,急诊PCI术前顿服阿托伐他汀钙1片(20mg),术后坚持服用3个月(20mg);分别在入院时、PCI术后即刻和PCI后24h3个时间段采取患者静脉血液,患者血浆中内皮微粒(EMPs)水平用流式细胞术检测,血清中超敏C反应蛋白(hs-CRP)水平用酶联免疫比浊法测定,从中分析两组血浆EMPs水平和血清hs-CRP水平间的变化,同时观察术中两组PCI术中冠脉TIMI血流情况和术后3个月内他汀药物副作用及总的MACE事件发生率。结果:1.两组患者之间血浆EMPs水平在各个时间点的比较:入院时比较,两组间患者血浆中EMPs的水平,P=0.5250.05,两组间无统计学意义;术后即刻间比较:较入院时两组患者血浆中EMPs的水平均升高(P0.05),且强化组血浆中EMPs的水平低于常规组;术后24h与术后即刻间的比较:较术后即刻两组患者血浆中EMPs的水平较术后即刻均降低(P0.05),而且强化组降低的更为明显。2.两组间患者各个时间点的血清中hs-CRP水平比较:入院时比较:两组患者在血清中hs-CRP水平比较,P=0.5690.05,两组间无统计学意义;术后即刻间比较:较入院时两组患者在血清中hs-CRP的水平较入院时均升高(P0.05),而且强化组较常规组血清中hs-CRP的水平低;术后24h与术后即刻间的比较:较术后即刻两组患者PCI后24h血清中hs-CRP的水平均降低(P0.05),而且强化组降低的更为显著。3.两组患者血浆EMPs水平与血清hs-CRP水平间的关系:根据相关性结果分析,血浆EMPs水平和血清hs-CRP水平间相关性较差(0r0.4,P0.05)。4.患者介入术中冠脉TIMI血流情况强化组和常规组比较:50例强化组中TIMI血流有效改善的患者47例(94%),50例常规组中有效的患者40例(80%),两组患者急诊术中冠脉TIMI血流改善情况的比较,P=0.037(P0.05),表明差异有统计学意义,可认为术前口服强化他汀药物可以改善急诊PCI术中冠脉血流,降低无复流的发生。5.安全性评价:术后3个月强化组与常规组在服用他汀药物发生副作用概率的比较:P=0.7120.05,差异无统计学意义,表明强化组与常规组两组间他汀副作用发生概率并无差别。术后3个月内两组患者总的MACE事件发生率比较P=0.0360.05,差异有统计学意义,可认为术前强化他汀治疗可降低近期患者MACE的发生率。结论:1.血浆EMPs及血清hs-CRP可间接反映急性冠脉综合症患者急诊PCI中冠脉内皮细胞炎症反应和损伤程度;2.强化他汀可降低患者急诊PCI术后血浆EMPs及血清hs-CRP水平,改善术中冠脉血流,降低短期内患者发生心血管不良事件;3.血浆EMPs水平和血清hs-CRP水平两者间的相关性较差;4.强化他汀与常规他汀药物治疗在安全性上无明显差别。
[Abstract]:Objective: To study the effect of intensive statin therapy on the level of endothelial particles (EMPs) and/ or high-sensitive C-reactive protein (hs-CRP) in peripheral circulating blood of patients with acute coronary syndrome. To discuss the enhancement of the inflammatory response of the statin to the endothelial cells of the patient and to observe the safety and short-term cardiovascular adverse events of the post-operative patient's enhanced statin therapy. Methods:100 patients with ACS who underwent emergency PCI were randomly divided into two groups according to the random method. The patients were divided into two groups according to the random method:50 cases of the patients,50 cases of the patients with emergency PCI,4 tablets of atorvastatin calcium (80 mg), and 3 months (40 mg) after the operation; 50 of the patients,1 tablet (20 mg) of atorvastatin calcium in emergency PCI, and 3 months (20 mg) after the operation; respectively, the patient's venous blood was taken at the time of admission, immediately after PCI and 24 hours after PCI, and the level of endothelial particles (EMPs) in the plasma of the patient was detected by flow cytometry. The serum levels of EMPs and hs-CRP in serum were measured by enzyme-linked immunosorbent assay (ELISA) in serum. Results:1. The level of EMPs in plasma of the two groups was significantly higher than that of the two groups at the time of admission (P = 0.525.05). There was no statistical significance between the two groups. The level of EMPs in plasma of the two groups was higher than that of the two groups at the time of admission (P0.05). The levels of EMPs in the plasma of the group were lower than that of the conventional group, and the levels of EMPs in the plasma of the two groups were decreased immediately after the operation (P0.05). The levels of hs-CRP in the serum of the two groups were compared with that of the two groups: the level of hs-CRP in the two groups was significantly higher in the two groups, P = 0.5690.05, no statistical significance between the two groups, and the level of hs-CRP in the two groups at the time of admission was higher than that at the time of admission (P0.05). In addition, the level of hs-CRP in the serum of the group was lower than that in the conventional group, and the level of hs-CRP in the 24 h serum after the operation was decreased (P0.05). The relationship between plasma EMPs and hs-CRP levels in the two groups was related to the correlation between the levels of EMPs and hs-CRP levels in the serum (0r0.4, P0.05). Compared with the conventional group, there were 47 patients (94%) and 40 (80%) of the 50 patients who had effective TIMI flow in the enhanced group, and 40 (80%) of the 50 patients in the conventional group, and the improvement of the coronary TIMI flow during the emergency operation of the two groups (P = 0.037 (P0.05). The difference is of statistical significance, and it can be considered that the pre-operative oral enhancement of statins can improve the coronary blood flow in emergency PCI and reduce the occurrence of no-reflow. Safety evaluation: There was no significant difference in the probability of side effects between the two groups after the operation. P = 0.7120.05, the difference was not statistically significant, indicating that there was no difference in the probability of the side effects between the two groups. The incidence of MACE events in the two groups was significantly higher than that of P = 0.0360.05 in 3 months after operation, and the difference was of statistical significance, and it was considered that preoperative intensive statin therapy could reduce the incidence of MACE in recent patients. Conclusion:1. Plasma EMPs and hs-CRP can indirectly reflect the degree of inflammatory response and injury of coronary endothelial cells in emergency PCI of patients with acute coronary syndrome. To enhance the level of plasma EMPs and serum hs-CRP in patients with emergency PCI, and to improve the coronary flow in the operation and to reduce the occurrence of cardiovascular adverse events in the short term. The correlation between the plasma EMPs level and the serum hs-CRP level was poor;4. There was no significant difference in safety between the enhancement of statins and conventional statin therapy.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.4
[Abstract]:Objective: To study the effect of intensive statin therapy on the level of endothelial particles (EMPs) and/ or high-sensitive C-reactive protein (hs-CRP) in peripheral circulating blood of patients with acute coronary syndrome. To discuss the enhancement of the inflammatory response of the statin to the endothelial cells of the patient and to observe the safety and short-term cardiovascular adverse events of the post-operative patient's enhanced statin therapy. Methods:100 patients with ACS who underwent emergency PCI were randomly divided into two groups according to the random method. The patients were divided into two groups according to the random method:50 cases of the patients,50 cases of the patients with emergency PCI,4 tablets of atorvastatin calcium (80 mg), and 3 months (40 mg) after the operation; 50 of the patients,1 tablet (20 mg) of atorvastatin calcium in emergency PCI, and 3 months (20 mg) after the operation; respectively, the patient's venous blood was taken at the time of admission, immediately after PCI and 24 hours after PCI, and the level of endothelial particles (EMPs) in the plasma of the patient was detected by flow cytometry. The serum levels of EMPs and hs-CRP in serum were measured by enzyme-linked immunosorbent assay (ELISA) in serum. Results:1. The level of EMPs in plasma of the two groups was significantly higher than that of the two groups at the time of admission (P = 0.525.05). There was no statistical significance between the two groups. The level of EMPs in plasma of the two groups was higher than that of the two groups at the time of admission (P0.05). The levels of EMPs in the plasma of the group were lower than that of the conventional group, and the levels of EMPs in the plasma of the two groups were decreased immediately after the operation (P0.05). The levels of hs-CRP in the serum of the two groups were compared with that of the two groups: the level of hs-CRP in the two groups was significantly higher in the two groups, P = 0.5690.05, no statistical significance between the two groups, and the level of hs-CRP in the two groups at the time of admission was higher than that at the time of admission (P0.05). In addition, the level of hs-CRP in the serum of the group was lower than that in the conventional group, and the level of hs-CRP in the 24 h serum after the operation was decreased (P0.05). The relationship between plasma EMPs and hs-CRP levels in the two groups was related to the correlation between the levels of EMPs and hs-CRP levels in the serum (0r0.4, P0.05). Compared with the conventional group, there were 47 patients (94%) and 40 (80%) of the 50 patients who had effective TIMI flow in the enhanced group, and 40 (80%) of the 50 patients in the conventional group, and the improvement of the coronary TIMI flow during the emergency operation of the two groups (P = 0.037 (P0.05). The difference is of statistical significance, and it can be considered that the pre-operative oral enhancement of statins can improve the coronary blood flow in emergency PCI and reduce the occurrence of no-reflow. Safety evaluation: There was no significant difference in the probability of side effects between the two groups after the operation. P = 0.7120.05, the difference was not statistically significant, indicating that there was no difference in the probability of the side effects between the two groups. The incidence of MACE events in the two groups was significantly higher than that of P = 0.0360.05 in 3 months after operation, and the difference was of statistical significance, and it was considered that preoperative intensive statin therapy could reduce the incidence of MACE in recent patients. Conclusion:1. Plasma EMPs and hs-CRP can indirectly reflect the degree of inflammatory response and injury of coronary endothelial cells in emergency PCI of patients with acute coronary syndrome. To enhance the level of plasma EMPs and serum hs-CRP in patients with emergency PCI, and to improve the coronary flow in the operation and to reduce the occurrence of cardiovascular adverse events in the short term. The correlation between the plasma EMPs level and the serum hs-CRP level was poor;4. There was no significant difference in safety between the enhancement of statins and conventional statin therapy.
【学位授予单位】：延安大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R541.4
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