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目的研究给予急性冠状动脉综合征(ACS)行经皮冠状动脉介入术(PCI)后患者40mg/d阿托伐他汀强化调脂,探讨该治疗方案对炎症因子、调脂疗效及临床心脏事件的影响,同时观察不良反应。方法92例ACS患者行PCI后,随机分为阿托伐他汀常规剂量(10mg/d,A组)和大剂量阿托伐他汀(40mg/d,B组)各46例,用药后4、12、24周抽外周静脉血,统一用ELISA法检测血清中高敏C-反应蛋白(hs-CRP)和金属蛋白酶-9(MMP-9)浓度,分析两组间差异,及其与调脂疗效的关系,并观测对肝功能、临床冠状动脉事件等影响。结果失访率A组6·5%(3例),B组8·6%(4例)。(1)两组患者用药后1~12周为丙氨酸氨基转移酶(ALT)出现异常的高峰期,1周,4周,12周异常例数A组比B组发生率少(P<0·05);多数ALT<3倍正常值,观察4周后恢复正常;而A组有2例(4·7%)、B组有3例(7·1%)的患者ALT>3倍正常值,需停药,两组各有2例肾功能异常。(2)A、B组患者的血脂下降率在给药12周后总胆固醇(TC)为12·3%比21·7%(P<0·05),给药24周后TC为11·1%比23·4%(P<0·05),低密度脂蛋白胆固醇(LDL-C)为10·0%比29·5%(P<0·05),差异有统计学意义。(3)A、B两组患者血清hs-CRP在服药后下降率分别为4周30·5%比21·8%、12周46·8%比64·3%、24周55·5%比71·7%(P<0·05);血清MMP-9下降率分别为4周49·1%比50·0%、12周72·7%比84·2%(P<0·05);二变量相关分析发现血清hs-CRP浓度下降与TC、LDL-C的变化呈线性相关;血清MMP-9浓度下降与TC、LDL变化也呈线性相关。(4)随访期内A、B两组不良心脏事件发生率差异无统计学意义。结论(1)阿托伐他汀40mg/d是安全的;(2)服用阿托伐他汀40mg/d可显著提高冠心病患者二级预防调脂的达标率,特别是LDL-C降至≤1·8mmol/L的目标值比例更高;(3)调脂强度与患者的血清hs-CRP与MMP-9的浓度下降趋势有线性相关。
Objective To investigate the effects of atorvastatin 40 mg / d on lipid peroxidation in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI) and to explore the effects of the treatment regimen on the inflammatory factors, lipid-lowering effects and clinical cardiac events , While observing adverse reactions. Methods 92 patients with ACS were randomly divided into two groups: atorvastatin (A group) and atorvastatin (40mg / d, group B) , Peripheral venous blood was drawn 24 weeks later. Serum levels of hs-CRP and MMP-9 were detected by ELISA. The differences between the two groups were analyzed, Relationship, and observed on liver function, clinical coronary events and other effects. Results The follow-up rate was 6.5% (3 cases) in group A and 8.6% (4 cases) in group B. (1) Abnormal peak of alanine aminotransferase (ALT) occurred in both groups at 1 to 12 weeks after treatment, and the number of abnormalities at 1 week, 4 weeks and 12 weeks was lower in group A than in group B (P < 0.05). Most patients with ALT <3 times normal returned to normal after 4 weeks of observation. In group A, there were 2 cases (4.7%) and in group B, 3 (7.1%) patients had ALT> 3 times Normal, need to be discontinued, two groups each have 2 cases of renal dysfunction. (2) The total cholesterol (TC) in group A and group B decreased 12.3% and 21.7% after 12 weeks of treatment (P <0.05) 1% was 23.4% (P <0.05), and LDL-C was 10.0% vs 29.5% (P <0.05), the difference was statistically significant. (3) The serum hs-CRP levels in group A and group B after treatment decreased by 30.5%, 21.8%, 46.8%, 64.3%, 55.5% Compared with 71.7% (P <0.05). The decreasing rate of MMP-9 in serum was 49.1%, 50.0%, 72.7%, 84.2% at 12 weeks (P <0.05) ). Two-variable correlation analysis showed that the decrease of serum hs-CRP was linearly correlated with the changes of TC and LDL-C. The decrease of serum MMP-9 concentration was also linearly correlated with the changes of TC and LDL. (4) There was no significant difference in the incidence of adverse cardiac events between A and B groups during the follow-up period. Conclusions (1) Atorvastatin 40mg / d is safe; (2) Atorvastatin 40mg / d can significantly improve the secondary prevention of lipid-lowering in patients with coronary heart disease, especially LDL-C to ≤1 · The target value of 8mmol / L was higher; (3) There was a linear correlation between the lipid fortification intensity and the decreasing tendency of serum hs-CRP and MMP-9 in patients.