强化阿托伐他汀对不稳定型心绞痛患者PCI围术期不同亚群单核细胞及单核细胞-血小板聚集体及预后的影响

doi:10.3969/j.issn.1671-7171.2018.02.022

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摘要【目的】探讨强化阿托伐他汀对不稳定型心绞痛(UAP)患者经皮冠状动脉介入术(PCI)围术期不同亚群单核细胞及单核细胞-血小板聚集体(MPA)及预后的影响。【方法】选择2015年6月至2017年6月本院收治的94例择期PCI术UAP患者的临床资料,按照随机数表法将患者分为观察组和对照组,每组各47例。两组患者均采用标准PCI手术治疗,对照组在PCI手术前后常规给予抗血小板、β受体阻滞剂等常规药物治疗,观察组在对照组基础上给予强化剂量阿托伐他汀治疗。对两组患者手术前后单核细胞不同亚群及MPA水平进行定量分析;比较两组患者PCI术前及术后的心肌肌钙蛋白I(cTnI)、磷酸肌酸激酶同工酶(CK-MB)及C反应蛋白(CRP)水平;观察记录患者术后的冠状动脉TIMI血流分级及术后无复流、慢血流发生情况;术后3个月随访记录两组患者不良心血管事件发生情况。【结果】观察组术后2型单核细胞(MON 2)、总MPA、1型单核细胞血小板聚集体及2型单核细胞血小板聚集体水平均显著低于对照组患者,差异具有统计学意义(P<0.05)。两组患者治疗后血清cTnI、CK-MB、CRP水平均显著升高,且观察组治疗后的cTnI、CK-MB、CRP水平均显著低于对照组,差异均具有统计学意义(P<0.05)。观察组术后TIMI血流分级显著优于对照组,而术后无复流及慢血流发生率均显著低于对照组,差异具有统计学意义(P<0.05)。观察组心血管不良事件总发生率显著低于对照组,差异具有统计学意义(P<0.05)。【结论】强化剂量的阿托伐他汀可能通过降低UAP患者单核细胞及MAP水平降低对心肌的损伤,可有效改善患者心肌血流状态和炎性反应,降低心血管事件发生风险。

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	缐海英
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关键词 ：心绞痛, 不稳定型/治疗, 血管成形术, 经腔, 经皮冠状动脉, 降血脂药/药理学, 手术期间, 单核细胞, 血小板聚集, 预后

Abstract：【Objective】To investigate the effect of intensive dose atorvastatin on different subsets of monocytes, monocytes, platelet aggregates (MPA) and prognosis in unstable angina pectoris (UAP) patients with PCI (percutaneous coronary intervention) during the perioperative period.【Methods】A total of 94 patients with UAP undergoing elective PCI surgery in our hospital from June 2015 to June 2017 were selected. According to the random number method, patients were divided into the study group (47 cases) and the control group (47 cases). The patients in both groups were treated with standard PCI. The control group was given conventional antiplatelet and β-blocker drugs before and after PCI. The observation group was given intensive doses of atorvastatin on the basis of the control group. The levels of monocytes and MPA in the two groups before and after surgery were analyzed quantitatively. The levels of cardiac troponin (cTnI), creatine phosphokinase (CK-MB) and C-reactive protein (CRP) were observed before and after PCI as well. The postoperative TIMI grading and postoperative no-reflow, slow blood flow of coronary were recorded. The incidence of adverse cardiovascular events was recorded at 3 months after operation in both groups.【Results】The levels of type 2 mononuclear cells (MON 2), total MPA, type 1 monocyte platelet aggregates and type 2 monocyte platelet aggregates in patients of the study group were significantly lower than those in the control group; the differences were statistically significant (P<0.05). After treatment, serum levels of cTnI, CK-MB and CRP in both groups significantly increased, while the levels of cTnI, CK-MB and CRP in patients of study group after treatment were significantly lower than those in the control group (P<0.05). The postoperative TIMI grade in the study group was significantly better than that in the control group, while the incidence of postoperative no-reflow and slow blood flow was significantly lower than that in the control group; the differences were statistically significant (P<0.05). The total incidence of adverse cardiovascular events in the study group was significantly lower than that in the control group with statistical significance (P<0.05); the study group patients with postoperative TIMI flow grade was significantly better than the control group, and after no reflow and slow flow rate were significantly lower than the control group, the difference was statistically significant (P<0.05); the total incidence of patients in the study group after treatment of adverse cardiovascular events was significantly lower than the control group, with the difference being statistically significant (P<0.05).【Conclusion】Intensive doses of atorvastatin may reduce myocardial damage by reducing monocyte and MAP levels in patients with UAP, and may effectively improve myocardial blood flow status and inflammatory response to decrease the risk of cardiovascular events.

Key words： Angina, Unstable/TH Angioplasty, Transluminal, Percutaneous Coronary Antilipemic Agents/PD Intraoperative Period Monocytes Platelet Aggregation Prognosis

收稿日期: 2017-09-25

PACS:

R541.42

引用本文:

缐海英,啜玉娟,沈彬,张爱华. 强化阿托伐他汀对不稳定型心绞痛患者PCI围术期不同亚群单核细胞及单核细胞-血小板聚集体及预后的影响[J]. 医学临床研究, 2018, 35(2): 274-277.
XIAN Hai-ying, CHUAI Yu-juan, SHEN Bin, et al. Effect of Intensive Dose Atorvastatin on Different Subsets of Monocytes and Monocytes Platelet Aggregates and Prognosis in Patients with Unstable Angina Pectoris during PCI. JOURNAL OF CLINICAL RESEARCH, 2018, 35(2): 274-277.

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http://www.jcr.net.cn/CN/10.3969/j.issn.1671-7171.2018.02.022 或 http://www.jcr.net.cn/CN/Y2018/V35/I2/274

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