瑞舒伐他汀对中年急性冠脉综合征患者PCI术后支架内再狭窄的影响
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摘要
目的:探讨瑞舒伐他汀对中年急性冠脉综合征(ACS)患者经皮冠动脉介入(PCI)术后支架内再狭窄的影响。方法:选取许昌市中心医院2016年3月-2017年4月收治的行PCI术的中年ACS患者400例为对象,按随机数字表法分为对照组和观察组,各200例。两组患者入院后均应用冠心病二级预防常规药物治疗,对照组患者术后口服硫酸氢氯吡格雷片75 mg,每日1次+阿司匹林肠溶片100 mg,每日1次+阿托伐他汀钙片20 mg,每晚1次;观察组患者术后口服硫酸氢氯吡格雷片75 mg,每日1次+阿司匹林肠溶片100 mg,每日1次+瑞舒伐他汀钙片10 mg,每晚1次。两组患者均连续治疗12个月。观察两组患者术前、术后1 d和术后1、3、6、12个月的血清三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hs-CRP)、白细胞介素35(IL-35)水平以及术后即刻和术后12个月的支架内最小管腔内径(MLD),并记录其支架内再狭窄、主要不良心血管事件(MACE)和药品不良反应(ADR)的发生情况。结果:对照组患者脱落14例,观察组脱落18例,共有368例患者完成本研究。术前或术后即刻,两组患者血清TG、TC、LDL-C、hs-CRP、IL-35水平和MLD比较,差异均无统计学意义(P>0.05);术后1 d,两组患者hs-CRP水平均较术前显著升高(P<0.05);术后1、3、6、12个月,两组患者血清TG、TC、LDL-C、hs-CRP水平均较术前显著下降,IL-35水平均较术前显著升高,且观察组患者血清TG、TC水平(术后1、3个月),LDL-C水平(术后3、6个月)和hs-CRP水平(术后1个月)均显著低于对照组,观察组IL-35水平(术后1个月)显著高于对照组(P<0.05)。术后12个月,两组患者MLD均显著缩小,但观察组显著大于对照组(P<0.05)。两组患者术后支架内再狭窄发生率以及MACE、ADR总发生率比较,差异均无统计学意义(P>0.05)。结论:瑞舒伐他汀能有效改善中年ACS患者PCI术后的血脂水平和炎症因子水平,且短期内的效果较阿托伐他汀更优;该药亦可延缓该类患者PCI术后支架内再狭窄的进程,且作用较阿托伐他汀更明显;同时,瑞舒伐他汀不会增加MACE、ADR发生的风险,安全性良好。
OBJECTIVE:To investigate the effects of rosuvastatin on in-stent restenosis in middle-aged patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI). METHODS:Totally 400 middle-aged ACS patients underwent PCI were selected from Xuchang Central Hospital during Mar. 2016 to Apr. 2017,and then divided into control group and observation group according to random number table,with 200 patients in each group. Both groups were given conventional drugs for secondary prevention of coronary heart disease. Control group were given Clopidogrel hydrogen sulfate tablets 75 mg,once a day + Aspirin enteric-coated tablets 100 mg,once a day + Atorvastatin calcium tablets 20 mg,once at bed time every day orally after PCI. Observation group was given Clopidogrel hydrogen sulfate tablets 75 mg,once a day + Aspirin enteric-coated tablets 100 mg,once a day+Rosuvastatin calcium tablets 10 mg,once at bed time every day orally after PCI. Both groups were treated for consecutive 12 months. The serum levels of TG,TC,LDL-C,hs-CRP and IL-35 were recorded in 2 groups before surgery,1,3,6 and 12 months after surgery;in-stent minimum lumen diameter(MLD)was observed immediately after surgery and 12 months after surgery. The occurrence of in-stent restenosis,major adverse cardiovascular events(MACE) and adverse drug reaction(ADR) were recorded. RESULTS:Totally 14 patients dropped out from control group and 18 from observation group,and 368 patients completed the study.Before surgery and immediately after surgery,there was no statistical significance in the serum levels of TG,TC,LDL-C,hs-CRP IL-35 or MLD(P>0.05). One day after surgery,the levels of hs-CRP were increased significantly in 2 groups,compared with before surgery(P<0.05). One,three,six and twelve months after surgery,the serum levels of TG,TC,LDL-C and hs-CRP were decreased significantly in 2 groups,while the levels of IL-35 were increased significantly,compared with before surgery;and the serum levels of TG and TC(1 and 3 months after surgery),LDL-C(3 and 6 months after surgery)and hs-CRP(1 month after surgery)in observation group were significantly lower than control group;the level of IL-35 in observation group(1 month after surgery)was significantly higher than control group(P<0.05). Twelve months after surgery,MLDs of 2 groups were decreased significantly,and observation group was significantly higher than control group(P<0.05). There was no statistical significance in the incidence of in-stent restenosis or the total incidence of MACE and ADR between 2 groups after surgery(P>0.05).CONCLUSIONS:Rosuvastatin can effectively improve the levels of blood lipid and inflammatory factor in meddle-aged patients with ACS after PCI,and its effect is better than that of atorvastatin. The drug can delay in-stent restenosis after PCI in these patients,which is better than the effect of atorvastatin. At the same time,rosuvastatin can not increase the risk of MACE and ADR with good safety.
OBJECTIVE:To investigate the effects of rosuvastatin on in-stent restenosis in middle-aged patients with acute coronary syndrome(ACS)after percutaneous coronary intervention(PCI). METHODS:Totally 400 middle-aged ACS patients underwent PCI were selected from Xuchang Central Hospital during Mar. 2016 to Apr. 2017,and then divided into control group and observation group according to random number table,with 200 patients in each group. Both groups were given conventional drugs for secondary prevention of coronary heart disease. Control group were given Clopidogrel hydrogen sulfate tablets 75 mg,once a day + Aspirin enteric-coated tablets 100 mg,once a day + Atorvastatin calcium tablets 20 mg,once at bed time every day orally after PCI. Observation group was given Clopidogrel hydrogen sulfate tablets 75 mg,once a day + Aspirin enteric-coated tablets 100 mg,once a day+Rosuvastatin calcium tablets 10 mg,once at bed time every day orally after PCI. Both groups were treated for consecutive 12 months. The serum levels of TG,TC,LDL-C,hs-CRP and IL-35 were recorded in 2 groups before surgery,1,3,6 and 12 months after surgery;in-stent minimum lumen diameter(MLD)was observed immediately after surgery and 12 months after surgery. The occurrence of in-stent restenosis,major adverse cardiovascular events(MACE) and adverse drug reaction(ADR) were recorded. RESULTS:Totally 14 patients dropped out from control group and 18 from observation group,and 368 patients completed the study.Before surgery and immediately after surgery,there was no statistical significance in the serum levels of TG,TC,LDL-C,hs-CRP IL-35 or MLD(P>0.05). One day after surgery,the levels of hs-CRP were increased significantly in 2 groups,compared with before surgery(P<0.05). One,three,six and twelve months after surgery,the serum levels of TG,TC,LDL-C and hs-CRP were decreased significantly in 2 groups,while the levels of IL-35 were increased significantly,compared with before surgery;and the serum levels of TG and TC(1 and 3 months after surgery),LDL-C(3 and 6 months after surgery)and hs-CRP(1 month after surgery)in observation group were significantly lower than control group;the level of IL-35 in observation group(1 month after surgery)was significantly higher than control group(P<0.05). Twelve months after surgery,MLDs of 2 groups were decreased significantly,and observation group was significantly higher than control group(P<0.05). There was no statistical significance in the incidence of in-stent restenosis or the total incidence of MACE and ADR between 2 groups after surgery(P>0.05).CONCLUSIONS:Rosuvastatin can effectively improve the levels of blood lipid and inflammatory factor in meddle-aged patients with ACS after PCI,and its effect is better than that of atorvastatin. The drug can delay in-stent restenosis after PCI in these patients,which is better than the effect of atorvastatin. At the same time,rosuvastatin can not increase the risk of MACE and ADR with good safety.
引文
[1]吕建峰,罗万权,张兴梅,等.不同强度他汀对中青年冠心病患者支架植入术后血脂水平的影响及安全性[J].重庆医科大学学报,2015,40(4):511-515.
[2]CENTURIóN OA.Serum biomarkers and source of inflammation in acute coronary syndromes and percutaneous coronary interventions[J].Cardiovasc Revasc Med,2016,17(2):119-128.
[3]康彦红,劳海燕,陈秀云,等.PON1基因启动子多态性及非遗传因素对PCI术后抗血小板治疗临床效应的影响[J].中国药理学通报,2012,28(12):1682-1686.
[4]张理科,陈宇.瑞舒伐他汀与阿托伐他汀治疗冠心病的疗效和安全性比较[J].中国药房,2016,27(12):1611-1613.
[5]曹洁,赵文强.瑞舒伐他汀钙与阿托伐他汀钙对冠心病患者空腹血糖和糖化血红蛋白影响的比较研究[J].齐齐哈尔医学院学报,2016,37(12):1529-1531.
[6]兰丙欣,徐炳欣,赵艳,等.CYP2C19基因多态性检测在PCI术后患者抗血小板治疗的价值研究[J].中国新药与临床杂志,2017,36(7):413-416.
[7]田恒松.口服瑞舒伐他汀防治冠脉支架后再狭窄52例[J].中国老年学杂志,2012,32(18):3991-3993.
[8]周永刚,蓝晓红,孙忠实.循证证据比较他汀类药物的获益与肌病相关风险的新进展[J].中国药学杂志,2015,50(17):1517-1520.
[9]MING EE,DAVIDSON MH,GANDHI SK,et al.Concomitant use of statins and CYP3A4 inhibitors in administrative claims and electronic medical records databases[J].J Clin Lipidol,2008,2(6):453-463.
[10]卢青,丁世芳,陈志楠,等.瑞舒伐他汀治疗急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后的临床研究[J].中国临床药理学杂志,2017,33(18):1735-1739.
[11]杨珍珍,赵存瑞,张锦,等.从血脂控制状况与支架内再狭窄的相关性看心脏康复管理的重要性[J].临床心血管病杂志,2017,33(7):650-652.
[12]陈涛,倪美玲,朱立场.瑞舒伐他汀钙与阿托伐他汀钙治疗高脂血症合并高血压的疗效比较[J].中国老年学杂志,2015,35(8):2017-2019.
[13]刘亦伟,林翠鸿,王长连,等.CYP3A4*18A、CYP3A4*18B和MDR1 C3435T基因多态性对阿托伐他汀血药浓度及疗效的影响[J].中国药学杂志,2016,51(19):1682-1689.
[14]陈强,沈东,黄党生,等.极晚期支架内血栓与支架内再狭窄患者的临床对比分析[J].中国循环杂志,2017,32(11):1056-1059.
[15]KITAGAWA K,HOSOMI N,NAGAI Y,et al.HS-CRPlevel is an independent predictor for recurrent stroke and vascular events in patients with non-cardiogenic brain infarction[J].J Neurol Sci,2017.DOI:10.1016/j.jns.2017.08.2452.
[16]TAYEFI M,TAJFARD M,SAFFAR S,et al.Hs-CRP is strongly associated with coronary heart disease(CHD):a data mining approach using decision tree algorithm[J].Comput Methods Programs Biomed,2017.DOI:10.1016/j.cmpb.2017.02.001.
[17]胡瑞兰,任俊,张冬凤.血浆IL-35水平评价冠心病及其与冠脉Gensini积分和LVEF的相关性[J].标记免疫分析与临床,2017,24(4):408-410.
[18]TAILAKH MA,FRIGER M,ZAHGER D,et al.Prospective study of the impact of diabetes mellitus newly diagnosed by glycated hemoglobin on outcomes in patients undergoing percutaneous coronary intervention[J].Eur J Intern Med,2017.DOI:10.1016/j.ejim.2016.09.007.
[19]程诚,王鑫.冠心病合并2型糖尿病患者PCI术后支架内再狭窄危险因素分析[J].中国循证心血管医学杂志,2018,10(2):196-202.
[20]姚立军,陈弹.瑞舒伐他汀与阿托伐他汀对冠心病患者血脂、动脉粥样硬化程度和血管内皮舒张功能的疗效对比[J].中国药房,2017,28(35):4963-4966.
[2]CENTURIóN OA.Serum biomarkers and source of inflammation in acute coronary syndromes and percutaneous coronary interventions[J].Cardiovasc Revasc Med,2016,17(2):119-128.
[3]康彦红,劳海燕,陈秀云,等.PON1基因启动子多态性及非遗传因素对PCI术后抗血小板治疗临床效应的影响[J].中国药理学通报,2012,28(12):1682-1686.
[4]张理科,陈宇.瑞舒伐他汀与阿托伐他汀治疗冠心病的疗效和安全性比较[J].中国药房,2016,27(12):1611-1613.
[5]曹洁,赵文强.瑞舒伐他汀钙与阿托伐他汀钙对冠心病患者空腹血糖和糖化血红蛋白影响的比较研究[J].齐齐哈尔医学院学报,2016,37(12):1529-1531.
[6]兰丙欣,徐炳欣,赵艳,等.CYP2C19基因多态性检测在PCI术后患者抗血小板治疗的价值研究[J].中国新药与临床杂志,2017,36(7):413-416.
[7]田恒松.口服瑞舒伐他汀防治冠脉支架后再狭窄52例[J].中国老年学杂志,2012,32(18):3991-3993.
[8]周永刚,蓝晓红,孙忠实.循证证据比较他汀类药物的获益与肌病相关风险的新进展[J].中国药学杂志,2015,50(17):1517-1520.
[9]MING EE,DAVIDSON MH,GANDHI SK,et al.Concomitant use of statins and CYP3A4 inhibitors in administrative claims and electronic medical records databases[J].J Clin Lipidol,2008,2(6):453-463.
[10]卢青,丁世芳,陈志楠,等.瑞舒伐他汀治疗急性ST段抬高型心肌梗死患者经皮冠状动脉介入术后的临床研究[J].中国临床药理学杂志,2017,33(18):1735-1739.
[11]杨珍珍,赵存瑞,张锦,等.从血脂控制状况与支架内再狭窄的相关性看心脏康复管理的重要性[J].临床心血管病杂志,2017,33(7):650-652.
[12]陈涛,倪美玲,朱立场.瑞舒伐他汀钙与阿托伐他汀钙治疗高脂血症合并高血压的疗效比较[J].中国老年学杂志,2015,35(8):2017-2019.
[13]刘亦伟,林翠鸿,王长连,等.CYP3A4*18A、CYP3A4*18B和MDR1 C3435T基因多态性对阿托伐他汀血药浓度及疗效的影响[J].中国药学杂志,2016,51(19):1682-1689.
[14]陈强,沈东,黄党生,等.极晚期支架内血栓与支架内再狭窄患者的临床对比分析[J].中国循环杂志,2017,32(11):1056-1059.
[15]KITAGAWA K,HOSOMI N,NAGAI Y,et al.HS-CRPlevel is an independent predictor for recurrent stroke and vascular events in patients with non-cardiogenic brain infarction[J].J Neurol Sci,2017.DOI:10.1016/j.jns.2017.08.2452.
[16]TAYEFI M,TAJFARD M,SAFFAR S,et al.Hs-CRP is strongly associated with coronary heart disease(CHD):a data mining approach using decision tree algorithm[J].Comput Methods Programs Biomed,2017.DOI:10.1016/j.cmpb.2017.02.001.
[17]胡瑞兰,任俊,张冬凤.血浆IL-35水平评价冠心病及其与冠脉Gensini积分和LVEF的相关性[J].标记免疫分析与临床,2017,24(4):408-410.
[18]TAILAKH MA,FRIGER M,ZAHGER D,et al.Prospective study of the impact of diabetes mellitus newly diagnosed by glycated hemoglobin on outcomes in patients undergoing percutaneous coronary intervention[J].Eur J Intern Med,2017.DOI:10.1016/j.ejim.2016.09.007.
[19]程诚,王鑫.冠心病合并2型糖尿病患者PCI术后支架内再狭窄危险因素分析[J].中国循证心血管医学杂志,2018,10(2):196-202.
[20]姚立军,陈弹.瑞舒伐他汀与阿托伐他汀对冠心病患者血脂、动脉粥样硬化程度和血管内皮舒张功能的疗效对比[J].中国药房,2017,28(35):4963-4966.
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