氯吡格雷联合阿托伐他汀早期干预对急性冠状动脉综合征患者炎症因子及血脂水平的影响  

Effect of early intervention of clopidogrel combined with atorvastatin on inflammatory cytokine and blood lipid level in patients with acute coronary syndrome

作　　者：李腾龙 王治忠 王芳 王玉蓉 

机构地区：[1]贵州省黔东南州人民医院,贵州凯里556000

出　　处：《现代中西医结合杂志》2008年第24期3727-3730,共4页Modern Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的观察在他汀类药物基础上加用氯吡格雷对急性冠状动脉综合征(ACS)患者炎症因子及血脂水平的影响。方法将72例ACS患者随机分为基本治疗组(常规用药+阿托伐他汀)和氯吡格雷组(氯吡格雷+常规用药+阿托伐他汀),观察治疗4周后血脂、可溶性血管细胞黏附分子-1(sVCAM-l)、白细胞介素1β(IL-1β)和高敏C反应蛋白(hs-CRP)的变化、临床疗效及不良反应。结果治疗后总胆固醇、三酰甘油和低密度脂蛋白胆固醇水平较治疗前明显下降(P均<0.05),sVCAM-lI、L-1β和高敏C反应蛋白水平均明显下降(P<0.05),但氯吡格雷组下降幅度大于基本治疗组(P<0.01)。氯吡格雷组胸痛缓解明显,无不良反应。结论阿托伐他汀联用氯吡格雷较单用阿托伐他汀可进一步降低致炎因子浓度,二者协同发挥抑制炎症、稳定斑块的作用。阿托伐他汀的抗炎作用独立于降脂作用以外。ACS患者早期联合应用他汀类药物及氯吡格雷治疗可能获益更大。Objective It is to observe the influence of early intervention of clopidogrel combine with atorvastatin on inflammatory cytokine and blood lipid level in patients with acute coronary syndrome （ACS）. Methods 72 patients were randomly divided into basic treatment group （conventional medication plus atorvastatin） and clopidogrel group （basic treatment plus clopidogrel）. After therapy for four weeks, the levels of sVCAM - 1, IL - 1, hs - CRP and blood lipids were measured, and the methods at base line and the fourth week after therapy. Likewise, blood lipids were measured, and the adverse reaction was observed. Results After therapy, the serum levels of total cholesterol, triglyceride and low density lipoprotein cholesterol （LDLC） in both groups were decreased significantly （P〈 0.05）, but there was no significance in the decreased degree between both groups. The serum levels of VCAM- 1, IL- 1β and hs-CRP were significantly decreased in both groups （P〈 0.05 ）, but the degree of reduction of them was greater in clopidogrel group than in basic treatment group （ P〈 0.01 ）. There were no correlation between the blood lipids change and serum inflammatory cytokine before and after therapy （ P 〉0.05）. Clopidogrel group could obviously ease chest pain and with no side effect. Conclusion Atorvastatin combine with clopidogrel have more beneficial effects on down regulating inflammatory and promoted the stability of atherosclerotic plaque than atorvastatin alone. Atorvastatin has no correlation with its lipids suppression ; early intensive atorvastatin treatment may yield more signif- icant benefits in the patients with ACS.

关 键 词：急性冠状动脉综合征 阿托伐他汀 氯吡格雷 可溶性血管细胞黏附分子-1 白细胞介素1Β 高敏C 反应蛋白 

分 类 号：R654.2[医药卫生—外科学]