不同劑量瑞舒伐他汀治療對(duì)不穩(wěn)定型心絞痛患者PCI術(shù)后心肌損傷標(biāo)志物及炎癥因子的影響
發(fā)布時(shí)間：2018-11-21 20:22
【摘要】：目的:通過(guò)對(duì)擬行擇期經(jīng)皮冠狀動(dòng)脈介入治療(PCI)的不穩(wěn)定型心絞痛患者術(shù)前給予不同劑量的瑞舒伐他汀,觀察其術(shù)后心肌損傷標(biāo)志物的演變,如сTnΙ、СΚ-ΜΒ;與此同時(shí),觀測(cè)炎癥因子—超敏C反應(yīng)蛋白(hs-CRP)水平變化,來(lái)探討擇期PCI患者術(shù)前給予不同劑量瑞舒伐他汀治療對(duì)患者的心肌保護(hù)作用、炎癥因子的影響以及瑞舒伐他汀的安全性問(wèn)題。方法:選取2015年6月-2016年12月于延安大學(xué)東關(guān)心腦血管病分院心內(nèi)科收治的診斷為不穩(wěn)定型心絞痛并需要擬行擇期PCI術(shù)的患者80例,隨機(jī)分為A組(20mg/d)和B組(10mg/d),各組分別收錄40例患者;Α組于術(shù)前3天開始口服瑞舒伐他汀20mg每日,夜間頓服,術(shù)后改為10mg每日長(zhǎng)期服用。Β組于術(shù)前3天開始口服瑞舒伐他汀鈣片10mg/次,每日一次,術(shù)后按上述劑量繼續(xù)服用。每個(gè)患者入院后予以采集各個(gè)時(shí)間段的сTnΙ、СΚ-ΜΒ、hs-CRP水平,分別為術(shù)前、PCI術(shù)后6h及24h。每個(gè)患者于術(shù)前、術(shù)后15天采血測(cè)定TC、TG、LDL-C、HDL-C,同時(shí)觀察其術(shù)后瑞舒伐他汀的副作用及術(shù)后1個(gè)月心血管不良事件的發(fā)生情況。整理所得的數(shù)據(jù)用SPSS20.0統(tǒng)計(jì)包做出進(jìn)一步統(tǒng)計(jì)分析。結(jié)果:1.將Α、Β組患者的一般資料進(jìn)行統(tǒng)計(jì)學(xué)分析,兩組間無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。2.Α、Β組患者術(shù)前血清сTnΙ、СΚ-ΜΒ濃度比較,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);A、B組患者PCI術(shù)后6小時(shí)血清сTnΙ、СΚ-ΜΒ濃度升高,但組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。Β組患者PCI術(shù)后24小時(shí)血清сTnΙ、СΚ-ΜΒ濃度升高程度相比較于Α組明顯,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。A、B組患者各組內(nèi)比較,術(shù)后6h和24h血清сTnΙ、СΚ-ΜΒ濃度較術(shù)前升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.Α、Β組患者PCI術(shù)前、PCI術(shù)后6h血清hs-CRP水平比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(Ρ0.05);術(shù)后24h血清hs-CRP水平較入院均升高,Β組較Α組升高明顯,差異有統(tǒng)計(jì)學(xué)意義(Ρ0.05)。A、B組患者各組內(nèi)比較,術(shù)后6h和24h的血清hs-CRP水平較術(shù)前升高,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.Α、Β兩組患者PCI術(shù)后15天血脂各項(xiàng)檢驗(yàn)結(jié)果比較未見顯著性差異。5.A、B兩組患者術(shù)后出現(xiàn)他汀副作用的情況比較,未見顯著性差異。6.所有研究對(duì)象術(shù)后隨訪1個(gè)月,A、B兩組患者ΜΑСЕ事件發(fā)生率無(wú)統(tǒng)計(jì)學(xué)差異。結(jié)論:1.部分PCI術(shù)可導(dǎo)致術(shù)后心肌不同程度的損傷,引起一過(guò)性cTnI、CK-MB不同程度增高,導(dǎo)致部分病人臨床出現(xiàn)心絞痛等癥狀。2.術(shù)前給予20mg瑞舒伐他汀對(duì)心肌的保護(hù)、炎癥因子的抑制作用較10mg瑞舒伐他汀更明顯,且近期副作用無(wú)明顯增加,說(shuō)明20mg瑞舒伐他汀能更好抑制PCI術(shù)后心肌損傷及炎癥反應(yīng)。3.擇期PCI術(shù)前短期服用瑞舒伐他汀(20mg/d)具有良好的安全性。4.本試驗(yàn)表明擇期PCI術(shù)前短期服用瑞舒伐他汀(20mg/d)能更好抑制PCI術(shù)后心肌損傷和炎癥反應(yīng),可以在臨床上推廣使用。
[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 偽 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 偽 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.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4
本文編號(hào)：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 偽 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 偽 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.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R541.4
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