不同他汀类药物对介入治疗后内皮功能的干预作用  

Effects of different statins on endothelial function after percutaneous coronary intervention

作　　者：郭进[1] 陈雯[1] 王风[1] 林虹[1] 赵毅兰[2] 王小燕[2] 焦伟[3] 

机构地区：[1]广西壮族自治区人民医院心内科,广西南宁530021 [2]广西壮族自治区人民医院超声科,广西南宁530021 [3]广西壮族自治区人民医院检验科,广西南宁530021

出　　处：《临床荟萃》2005年第19期1081-1085,共5页Clinical Focus

基　　金：广西科学基金资助项目(No:桂科基0156023)

摘　　要：目的了解冠心病(CHD)患者介入治疗(PCI)前后血管内皮功能状态及比较不同他汀类药物(普伐他汀、阿托伐他汀)对PCI后内皮功能的影响。方法选择经冠状动脉造影证实冠状动脉单支或双支以上≥70%狭窄患者60例,于成功行PCI后在常规治疗(阿司匹林、血管紧张素转化酶抑制剂、硝酸酯类)的基础上按分层随机分配法分为普伐他汀组(30例)和阿托伐他汀组(30例)。全部患者采用高分辨超声技术分别在PCI前、PCI后3天(干预前)和8周(干预后)检测肱动脉舒张功能:反应性充血后血管舒张(FMD)、含服硝酸甘油后的血管舒张(NID),且同步检验血内皮素(ET)、一氧化氮(NO)及肝肾功能、血脂等指标并进行对比分析。结果①两组PCI后3天的FMD、NO均较PCI前显著下降(均P<0.05),ET则升高(均P<0.05);两组间PCI前、后的上述指标比较差异均无统计学意义(P>0.05)。②两组干预后的FMD、NO较干预前显著上升(均P<0.05),ET则降低(P<0.05);两组间干预前、后的上述指标比较差异均无统计学意义(P>0.05)。③NID在各组PCI前后、干预前后及组间比较差异均无统计学意义(P>0.05)。④干预后的血总胆固醇:阿托伐他汀组较普伐他汀组明显降低(P<0.05)。结论CHD患者PCI后均出现明显的血管内皮舒张功能障碍;FMD、NO、ET为反映CHD患者PCI后血管内皮功能的指标;血管内皮功能障碍在PCI后血管再狭窄起始机制中可能具有重要意义;应用不同他汀类药物(普伐他汀、阿托伐他汀)均能改善PCI后血管内皮功能,且安全性好;阿托伐他汀还具明显的降脂的作用。Objective To investigate the blood vessel endothelial function status of coronary heart disease （CHD） individuals before and after percutaneous coronary intervention （PCI） and, in the meantime, to compare the interference effects of different statin drugs （pravastatin and atovastatin） on endothelium functions after PCI. Methods Having been diagnosed ≥70% stenosis symptoms in single or twin and（or） more coronary arteries by using coronary artery photography technique, 60 CHD patients were chosen for the observation. The selected cases, who had been successfully undergone PCI and were subject to conventional treatment with the aspirin, ACEI and nitroglycerin drugs, then divided into pravastatin group （n=30） and atovastatin group （n=30） based on stratified randomization. Various brachial artery vasodilation functions, including flow mediated vasodilation （FMD） and nitroglycerin-induced vasodilation （NID） of all cases in both groups were observed before PCI, 3 days after PCI （before intervention） and 8 weeks after PCI （after intervention） by applying high resolution ultrasound technique and, in the meantime, the levels of endothelium （ET）, nitric oxide （NO） and liver ＆ kidney functions as well as the indexes of blood lipid and total cholesterin（TC） were also tested synchronously. The results thus obtained were analyzed and compared accordingly. Results ① Three days after PCI, the levels of both FMD and NO in the two groups had significantly dropped compared to those before PCI （P 〈0.05）, in contrast, ET had significantly increased （ P〈0.05）; the above mentioned indexes showed no differences （P〉0.05） between the two groups before and after PCI.②After intervention, the levels of both FMD and NO in the two groups had significantly increased compared to those before intervention （ P〈0.05）, in contrast, ET had significantly dropped （ P〈0.05） ; the above-mentioned indexes showed no differences （ P〉0.05） between the two groups b

关 键 词：普伐他汀 阿托伐他汀 内皮 血管 

分 类 号：R541[医药卫生—心血管疾病]