强化调脂对急性冠状动脉综合征患者促炎和抗炎失衡的影响  

Effect of intensive lipid-lowering therapy on the imbalance between inflammatory and anti-inflammatory responses in patients with acute coronary syndrome

作　　者：牛楠[1] 曲鹏[1] 王虹艳[1] 徐丹[1] 崔颖[2] 丁彦春[1] 朱宁[1] 

机构地区：[1]大连医科大学附属第二医院心内科,116027 [2]北京市丰台区南苑医院内科

出　　处：《中国医师进修杂志（内科版）》2008年第7期26-29,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的观察强化调脂对急性冠状动脉综合征（ACS）患者促炎和抗炎失衡的影响，探讨阿托伐他汀抗炎和稳定斑块的机制。方法检测82例ACS患者、17例稳定型心绞痛（SAP）患者和22例对照者的高敏C反应蛋白（hs—CRP）和IL-10水平。将41例应用阿托伐他汀调脂治疗的ACS患者随机分为标准治疗组（阿托伐他汀10mg／d）及强化治疗组（阿托伐他汀40mg／d），观察治疗前和治疗1个月后血脂、hs—CRP及IL-10水平的变化。结果ACS患者hs-CRP水平[（11．10±14．30）mg/L]明显高于SAP患者[（2．47±2．72）mg／L]和对照者[（2．34±4．22）mg／L]，P均〈0．05；ACS思者IL-10水平[（3．94±1．91）ng／L]明显低于SAP患者[（6．31±4．26）ng／L]和对照者[（7．76±2．82）ng／L]，P均〈0．05。强化治疗组与标准治疗组患者治疗后hs—CRP水平明显降低（P〈0．05），IL-10水平明显升高（P〈0．05），且强化治疗作用更强（P〈0．05）。结论ACS患者hs—CRP水平明显升高，但IL-10水平明显降低，提示机体斑块不稳定与促炎和抗炎失衡有关。阿托伐他汀强化治疗能明显降低hs-CRP水平，升高IL-10水平，提示其稳定斑块的作用可能与改善促炎和抗炎失衡有关。Objective To investigate the effect of intensive lipid-lowering therapy on the imbalance between inflammatory and anti-inflammatory responses in patients with acute coronary syndrome （ACS）. Methods Observed serum levels of hs-CRP and IL-10 in 82 patients with ACS, 17 patients with stable angina, and 22 controls. Forty-one patients with ACS were randomized to take either atorvastatin 10 mg/d （standard lipid-lowering therapy） or atorvastatin 40 mg/d （intensive lipid-lowering therapy） for one month in addition to their routine anti-anginal treatment. Serum levels of hs-CRP, blood lipids, IL-10 were investigated.IL-10 was measured by ELISA. Results The level of hs-CRP in patients with ACS [ （ 11.10 ± 14.30） mg/L] was higher than that in patients with stable angina [ （2.47 ± 2.72） mg/L]and controls [ （2.34 ± 4.22） mg/L ] （P all 〈 0.05 ）. The level of IL-10 was lower in ACS patients [ （3.94 ± 1.91 ）ng/L ]compared with those who had stable angina [ （6.31 ± 4.26） ng/L] and controls [ （7.76 ± 2.82） ng/L], P all 〈 0.05. The level of hs-CRP in patients with ACS was decreased and IL-10 was increased after one month treatment with atorvastatin （P 〈 0.05 ）.The effect of atorvastatin 40 mg/d was more effective than that of atorvastatin 10 mg/d. Conclusions Patients with ACS have higher level of hs-CRP and lower level of IL-10 than those with stable angina. This finding suggests that imbalance of inflammatory and anti-inflammatory responses is related with aggravation of atherosclerotic disease. Intensive lipid-lowering therapy is more effective than standard lipid-lowering therapy on ameliorating the imbalance.

关 键 词：冠状动脉疾病 降血脂药 阿托伐他汀 白细胞介素10 

分 类 号：R543.3[医药卫生—心血管疾病] R541.4[医药卫生—内科学]