阿托伐他汀和普罗布考联合治疗对冠脉临界病变患者冠脉病变程度的协同作用  

Synergistic effect of atorvastatin and probucol on severity of coronary lesion in patients with borderline coronary lesion

作　　者：葛长江[1] 吕树铮[1] 柳弘[1] 冯利霞[1] 宋现涛[1] 陈欣[1] 孟康[1] 苑飞[1] 季凤清[2] 霍勇[3] 

机构地区：[1]首都医科大学附属北京安贞医院心内科,北京100029 [2]首都医科大学基础医学院组织胚胎教研室 [3]北京大学第一医院心内科

出　　处：《中华急诊医学杂志》2012年第3期277-281,共5页Chinese Journal of Emergency Medicine

基　　金：国家“十一五”科技支撑计划（2006BAI01A02）;首都医科大学基础与临床合作基金课题（11JLS1）;北京安贞医院科技发展基金（20070213）

摘　　要：目的研究冠脉临界病变患者血浆胱抑素c水平（plasma cystatin C concentration，PcyC）的变化，探讨阿托伐他汀和普罗布考的联合治疗对其PcyC水平和冠脉病变严重程度的影响。方法连续入选2006年5月至2010年11月在北京安贞医院住院经定量冠脉造影检查确诊冠脉临界病变130例（borderline coronary lesion，BCL），136例无冠脉病变的受试者纳入对照组（controls，CTR）。BCL组患者被随机（随机密封信封法）分为常规治疗组（routine treatment，RTT，n=60）和联合治疗组（combined treatment，CBT，n=70），连续治疗6个月。联合治疗组除常规药物治疗外，每日加用阿托伐他汀20mg和普罗布考1．0g。各组性别、年龄等一般资料间比较差异均无统计学意义，具有可比性。检测其血PcyC和高敏C-反应蛋白（high—sensitive C-reactive protein，hs—CRP）水平，以及总胆固醇（total cholesterol，TC）、低密度脂蛋白胆固醇（low-density lipoprotein cholesterol，LDL—C）、高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL—C）及甘油三酯（triglycerides，TG）浓度。其中BCL组104例受试者复查冠脉造影。两组间均数比较采用t检验和方差分析，计数资料使用X^2检验，以P〈0．05为差异具有统计学意义。结果BCL组PcyC水平明显高于CTR组（P〈0．05）。与RTT组相比，CBT组PcyC水平、TC、LDL—C、TG、和hs-CRP明显降低（P〈0．05，P〈0．01）。此外，治疗6个月后RTT组冠脉临界病变的平均狭窄程度（mean percent stenosis，MPS）有所下降（P〉0．05），而CBT组却见明显减低（P〈0．05）。结论PcyC参与冠状动脉疾病的病理过程，且与冠脉病变的严重程度密切相关。阿托伐他汀和普罗布考的联合应用可降低PcyC水平，其可能是冠脉临界病变治疗的选择。Objective To study the changes of plasma cystatin C level （PcyC）, and evaluate the effects of the joint use of atorvastatin and probucol on PcyC and severity of coronary lesion in patients with borderline lesion of coronary artery. Methods One hundred and thirty consecutive patients with borderline coronary lesion assessed by quantitative coronary angiography were enrolled into borderline coronary lesion group （BCL）, and another 136 subjects without coronary lesion were enrolled as controls （CTR）. And in the meantime, the subjects in BCL group were randomized（ closed envelope method） into routine treatment subgroup （ RTT, n = 60）, and combined treatment subgroup in which patients were treated with atorvastatin 20 mg plus probucol 1.0 g daily in addition to routine medication （ CBT, n = 70） for 6 months. There were no statistical differences in basic clinical features between two subgroups. PcyC, high-sensitive C-reactive protein （hs-CRP）, total cholesterol （TC）, low-density lipoprotein cholesterol （LDL-C）, high-density lipoprotein cholesterol （HDL-C） and triglycerides （TG） were determined. Of them, 104 patients in BCL group rechecked by coronary angiography. Comparison of biomarkers carried out between two groups by using a number of independent-sample t-test and analysis of variance. For enumeration data, chi-square test was used to compare mean values of biomarkers between groups.. P 〈 0.05 was considered statistically significant. Results PcyC levels were significantly higher in BCL group than those in CTR group （P 〈 0. 05 ）. Compared with RTT subgroup, levels of PcyC, TC, LDL-C, TG and hs-CRP were more significantly decreased in CBT subgroup （P 〈 0. 05, P 〈 0. 01 ）. Moreover, there was a trend of slight decrease in the mean percent of stenosis （MPS） of coronary artery with borderline lesion in RTF subgroup treated for 6 months, whereas more marked decrease in the MPS of coronary artery with borderline coronary lesion in CBT subgroup treated for 6

关 键 词：胱抑素C 冠状动脉疾病 冠状动脉临界病变 

分 类 号：R541.4[医药卫生—心血管疾病]