高强度阿托伐他汀对冠状动脉支架术后患者内膜增生及炎性因子的影响  

Influence of large dose Atorvastatin on the level of Inflammatory Factors and Intimal Hyperplasia in Patients with Coronary Artery Stenting

作　　者：曹高镇 扬大浩 衣晨[2] 吴保泉 曾繁芳[2] 赵洪磊[2] CAO Gao-zhen;YANG Da-hao;YI Chen;WU Bao-quan;ZENG Fan-fang;ZHAO Hong-lei

机构地区：[1]广东省深圳市香港大学深圳医院心内科,广东深圳518000 [2]深圳市孙逸仙心血管医院内科,广东深圳518112

出　　处：《中国药物经济学》2018年第5期38-41,共4页China Journal of Pharmaceutical Economics

基　　金：深圳市三名工程项目(No.SZSM201612056)

摘　　要：目的观察高强度阿托伐他汀对急性冠状动脉综合征患者冠状动脉支架植入术后内膜增生及炎性因子水平的影响。方法选取2015年2月至2016年5月接受冠状动脉支架植入术治疗的冠状动脉粥样硬化性心脏病患者117例作为研究对象,随机分为对照组59例和研究组58例,所有患者均接受规范的冠心病二级预防方案治疗,对照组患者给予阿托伐他汀20 mg治疗,1次/d;研究组患者给予阿托伐他汀40 mg治疗,1次/d。记录患者冠状动脉支架植入术后即刻及6~9个月后复查冠状动脉造影和血管内超声,观察支架内的最小冠状动脉血管直径、内膜增生面积等,并检测患者支架植入前后炎性因子水平。结果两组患者均未发生心脏不良事件和再次支架植入术。研究组有112处病变植入支架,对照组有91处病变植入支架,且均完成冠状动脉造影和血管内超声随访。研究组与对照组患者支架内晚期管腔丢失[(0.18±0.29)mm比(0.33±0.71)mm]和节段内晚期管腔丢失[(0.17±0.04)mm比(0.39±0.43)mm]比较,差异有统计学意义(P<0.01)。研究组的冠状动脉支架内平均内膜增生面积与对照组[(0.4±0.6)mm2比(1.3±1.3)mm2]比较,差异有统计学意义(P<0.01)。两组患者术后基质金属蛋白酶-1、基质金属蛋白酶-9、超敏C反应蛋白、低密度脂蛋白水平较术前均明显下降,差异均有统计学意义(均P<0.05);但研究组炎性因子水平下降更为明显,与对照组比较差异有统计学意义(P<0.001)。结论 40 mg阿托伐他汀可显著抑制急性冠状动脉综合征患者血管内皮炎性反应,有效减少内膜增生,减少支架内管腔丢失,从而降低支架内再狭窄的发生率。Objective To observe the effect of Atorvastatin on the intimal hyperplasia of in-stent and the level of inflammatory factors in patients with coronary heart disease after coronary stent implantation.Methods From February 2015 to May 2016, 117 patients with coronary heart disease were received standard scheme and stent implantation. All patients were randomly divided into 58 cases of study group and 59 cases of control group. On the basis of routine therapy, control group was treated with Atorvastatin 20 mg qd, the study group was treated with Atorvastatin 40 mg qd. The minimal lumen diameter and intimal hyperplasia area and minimal lumen area of inside stent were recorded after stenting immediately and 6-9 months later. The levels of systemic inflammatory factors were measured before and after stent implantation.Results Cardiac adverse events and second stent implantations were not occurred in the two groups. Study group had 112 lesions were placed stents, and the control group had 91 stents. Study group compared with moderate intensity statin therapy group in stent late lumen loss [（0.18±0.29） mm vs.（0.33±0.71） mm] and in segment late lumen loss [（0.17±0.04） mm vs.（0.39±0.43）mm], there were significant differences（P〈0.01）.The average intimal hyperplasia area [（0.36±0.59） mm2 vs.（1.28±1.27） mm2] was significantly higher than that of moderate intensity statin treatment in the coronary stent, the difference was statistically significant（P〈0.01）. The MMP-1, MMP-9, LDL-C and hs-CRP levels of patients in the two groups were significantly decreased compared with those before operation（P〈0.05）, but the levels of inflammatory factors decreased significantly in the treatment group（P〈0.001）.Conclusion 40 mg Atorvastatin can reduce the diameter of stent lumen and intimal hyperplasia after coronary stent implantation, inhibit the inflammatory reaction, and then prevent restenosis.

关 键 词：高强度他汀 晚期管腔丢失 血管内超声 炎性因子 

分 类 号：R541.4[医药卫生—心血管疾病]