阿托伐他汀强化剂量用于不稳定型心绞痛经皮冠状动脉介入治疗的免疫及心肌炎性调节作用  

Effect of intensive dose of atorvastatin applied in percutaneous coronary intervention for unstable angina pectoris in regulating immune and myocardial inflammatory reactions

作　　者：黄兴清 许勇[1] 冯仕勇[1] 陈晓玲[1] HUANG Xing-qing XU Yong FENG Shi-yong CHEN Xiao-ling(The Second People＇s Hospital of Deyang City, Deyang, Sichuan 618000, China)

机构地区：[1]德阳市第二人民医院,四川德阳618000

出　　处：《岭南心血管病杂志》2017年第3期262-265,341,共5页South China Journal of Cardiovascular Diseases

摘　　要：目的研究阿托伐他汀强化剂量用于不稳定型心绞痛经皮冠状动脉介入(percutaneous coronary interven-tion,PCI)治疗的免疫及心肌炎性调节作用。方法纳入德阳市第二人民医院90例不稳定型心绞痛患者作为研究对象,均接受PCI治疗,抽签随机分为观察组(n=49,强化剂量阿托伐他汀),对照组(n=41,常规阿托伐他汀)。观察两组白细胞介素-10(interleukin-10,IL-10)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)、超敏C-反应蛋白(hypersensitive C-reactive protein,hs-CRP)、肌酸激酶同工酶MB(creatine kinase isoenzyme-MB,CK-MB)及肌钙蛋白(troponin,Tn I)等心肌炎性指标和CD4+T淋巴细胞微小核糖核酸(miRNA)-21表达情况,并观察术后不良事件发生率。结果观察组术后1 d的TNF-α浓度低于对照组[(0.26±0.05)pg/mL vs.(0.44±0.11)pg/m L,P<0.05]、IL-10浓度高于对照组[(13.26±3.48)pg/mL vs.(10.43±2.52)pg/mL,P<0.05],差异有统计学意义。术后1 d观察组hs-CRP、CK-MB及Tn I浓度显著低于对照组,差异有统计学意义(P<0.05)。观察组术后1 d、1周及2周miRNA-21表达水平均显著高于对照组,差异有统计学意义(P<0.05)。miRNA-21表达水平与IL-10和TNF-α具有显著相关性(P<0.05)。观察组术后心绞痛和谷丙转氨酶(ALT)异常升高发生率分别为2.04%和4.08%,均显著低于对照组,差异有统计学意义(P<0.05)。结论阿托伐他汀强化剂量用于不稳定型心绞痛患者PCI治疗前干预,能显著减少心肌炎性损伤和术后心血管不良事件发生率,这可能与阿托伐他汀上调miRNA-21表达,抑制TNF-α浓度,促进IL-10分泌有关。Objectives To study the effect of intensive dose of atorvastatin applied in percutaneous coronary interven-tion（PCI）for unstable angina pectoris in regulating immune and myocardial inflammatory reactions. Methods Ninetypatients with unstable angina pectoris in The Second People＇s Hospital of Deyang City were enrolled in the study.Patients in both groups underwent PCI and were randomized into observation group（n=49,intensive dose of atorvastatin）and control group（n=41,routine dose of atorvastatin）. Interleukin-10（IL-10）,tumor necrosis factor-α（TNF-α）,hy-persensitive C-reactive protein（hs-CRP）,creatine kinase isoenzyme-MB（CK-MB）,troponin I（TnI）and other myo-cardial inflammatory indexes and expression of CD4^＋T lymphocyte micro ribonucleic acid（miRNA）-21 in the twogroups were observed. Incidence of adverse events was also observed. Results One day after operation,TNF-α[（0.26±0.05）pg/mL vs.（0.44±0.11）pg/mL,P〈0.05]in observation group was lower than that in the control group while IL-10[（13.26±3.48）pg/mL vs.（10.43±2.52）pg/mL,P〈0.05]was higher. One day after operation,concentrations of hs-CRP,CK-MB and Tn I in observation group were significantly lower than those in control group（P〈0.05）. One day,1 week and 2 weeks after operation,expression levels of miRNA-21 in observation group were significantly higherthan those in control group（P〈0.05）. Expression level of miRNA-21 was significantly positively correlated with IL-10 and TNF-α（P〈0.05）. Incidence rates of angina pectoris and abnormally elevation of alanine aminotransferase（ALT）in observation group after operation（2.04%,4.08%）were significantly lower than those in control group（P〈0.05）.Conclusions Application of intensive dose of atorvastatin in intervention before PCI for patients with unstable angina pectoris can significantly reduce the incidence of myocardial inflammatory injury and postoperative cardiovascularadverse events,which may be related to atorvastatin upre

关 键 词：阿托伐他汀 强化治疗 不稳定型心绞痛 免疫 心肌炎性反应 

分 类 号：R541.4[医药卫生—心血管疾病]