中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2013年
13期
31-34
,共4页
徐瑞金%潘茗%纪霞%孙元芬
徐瑞金%潘茗%紀霞%孫元芬
서서금%반명%기하%손원분
老年人%糖尿病%急性冠状动脉综合征%血管成形术,气囊,冠状动脉%氟伐他汀
老年人%糖尿病%急性冠狀動脈綜閤徵%血管成形術,氣囊,冠狀動脈%氟伐他汀
노년인%당뇨병%급성관상동맥종합정%혈관성형술,기낭,관상동맥%불벌타정
Aged%Diabetes mellitus%Acute coronary syndrome%Angioplasty,balloon,coronary%Fluvastatin
目的 评价氟伐他汀缓释片对急性冠状动脉综合征(ACS)合并糖尿病老年患者经皮冠状动脉介入治疗(PCI)后的影响及药物安全性.方法 选择2009年12月至2011年12月收治年龄≥65岁的ACS合并糖尿病行PCI患者78例,均应用药物洗脱支架行PCI,按随机数字表法分为A组(氟伐他汀缓释片80 mg/d)和B组(氟伐他汀缓释片160 mg/d),每组39例,术前、术后24h、术后7d检测血清高敏C反应蛋白(hs-CRP)、基质金属蛋白酶9(MMP-9)、单核细胞趋化蛋白1 (MCP-1)和血脂水平.随访180d观察药物不良反应和心血管事件.结果 两组术前、术后血脂水平无显著性变化.两组术后24h血清hs-CRP、MCP-1、MMP-9水平均高于术前[A组:(12.14±2.71) mg/L比(8.76±2.25) mg/L、(491.75±19.29) ng/L比(440.56±13.15) ng/L、(449.6±11.8)μmol/L比(353.8±16.0) mol/L；B组:(11.39±2.38) mg/L比(9.30±1.99)mg/L、(488.56±17.61) ng/L比(436.06±15.36) ng/L、(444.9± 19.1)μmol/L比(349.8±13.6)μmol/L],差异有统计学意义(P＜0.05).两组术后7d及随访180 d血清hs-CRP、MCP-1、MMP-9水平较术后24h下降,且B组比A组下降明显[术后7 d:(4.51±1.16) mg/L比(5.43±1.44) mg/L、(306.06±18.49) ng/L比(384.64±13.23) ng/L、(206.2±16.8) μmol/L比(263.4±15.4)μmol/L;随访180 d:(4.23±1.08) mg/L比(4.68±1.46) mg/L、(280.16±14.54) ng/L比(354.64±11.32) ng/L、(187.2±14.2)μmol/L比(225.4±12.7)μmol/L],差异有统计学意义(P＜0.05).随访180d两组均未发生严重药物不良反应,B组总的心血管事件发生率低于A组[7.7％(3/39)比25.6％(10/39)],差异有统计学意义(P＜0.05).结论 强化降脂更能降低ACS合并糖尿病老年患者PCI术后炎性因子水平,减少心血管事件,并具有很好的安全性.
目的 評價氟伐他汀緩釋片對急性冠狀動脈綜閤徵(ACS)閤併糖尿病老年患者經皮冠狀動脈介入治療(PCI)後的影響及藥物安全性.方法 選擇2009年12月至2011年12月收治年齡≥65歲的ACS閤併糖尿病行PCI患者78例,均應用藥物洗脫支架行PCI,按隨機數字錶法分為A組(氟伐他汀緩釋片80 mg/d)和B組(氟伐他汀緩釋片160 mg/d),每組39例,術前、術後24h、術後7d檢測血清高敏C反應蛋白(hs-CRP)、基質金屬蛋白酶9(MMP-9)、單覈細胞趨化蛋白1 (MCP-1)和血脂水平.隨訪180d觀察藥物不良反應和心血管事件.結果 兩組術前、術後血脂水平無顯著性變化.兩組術後24h血清hs-CRP、MCP-1、MMP-9水平均高于術前[A組:(12.14±2.71) mg/L比(8.76±2.25) mg/L、(491.75±19.29) ng/L比(440.56±13.15) ng/L、(449.6±11.8)μmol/L比(353.8±16.0) mol/L；B組:(11.39±2.38) mg/L比(9.30±1.99)mg/L、(488.56±17.61) ng/L比(436.06±15.36) ng/L、(444.9± 19.1)μmol/L比(349.8±13.6)μmol/L],差異有統計學意義(P＜0.05).兩組術後7d及隨訪180 d血清hs-CRP、MCP-1、MMP-9水平較術後24h下降,且B組比A組下降明顯[術後7 d:(4.51±1.16) mg/L比(5.43±1.44) mg/L、(306.06±18.49) ng/L比(384.64±13.23) ng/L、(206.2±16.8) μmol/L比(263.4±15.4)μmol/L;隨訪180 d:(4.23±1.08) mg/L比(4.68±1.46) mg/L、(280.16±14.54) ng/L比(354.64±11.32) ng/L、(187.2±14.2)μmol/L比(225.4±12.7)μmol/L],差異有統計學意義(P＜0.05).隨訪180d兩組均未髮生嚴重藥物不良反應,B組總的心血管事件髮生率低于A組[7.7％(3/39)比25.6％(10/39)],差異有統計學意義(P＜0.05).結論 彊化降脂更能降低ACS閤併糖尿病老年患者PCI術後炎性因子水平,減少心血管事件,併具有很好的安全性.
목적 평개불벌타정완석편대급성관상동맥종합정(ACS)합병당뇨병노년환자경피관상동맥개입치료(PCI)후적영향급약물안전성.방법 선택2009년12월지2011년12월수치년령≥65세적ACS합병당뇨병행PCI환자78례,균응용약물세탈지가행PCI,안수궤수자표법분위A조(불벌타정완석편80 mg/d)화B조(불벌타정완석편160 mg/d),매조39례,술전、술후24h、술후7d검측혈청고민C반응단백(hs-CRP)、기질금속단백매9(MMP-9)、단핵세포추화단백1 (MCP-1)화혈지수평.수방180d관찰약물불량반응화심혈관사건.결과 량조술전、술후혈지수평무현저성변화.량조술후24h혈청hs-CRP、MCP-1、MMP-9수평균고우술전[A조:(12.14±2.71) mg/L비(8.76±2.25) mg/L、(491.75±19.29) ng/L비(440.56±13.15) ng/L、(449.6±11.8)μmol/L비(353.8±16.0) mol/L；B조:(11.39±2.38) mg/L비(9.30±1.99)mg/L、(488.56±17.61) ng/L비(436.06±15.36) ng/L、(444.9± 19.1)μmol/L비(349.8±13.6)μmol/L],차이유통계학의의(P＜0.05).량조술후7d급수방180 d혈청hs-CRP、MCP-1、MMP-9수평교술후24h하강,차B조비A조하강명현[술후7 d:(4.51±1.16) mg/L비(5.43±1.44) mg/L、(306.06±18.49) ng/L비(384.64±13.23) ng/L、(206.2±16.8) μmol/L비(263.4±15.4)μmol/L;수방180 d:(4.23±1.08) mg/L비(4.68±1.46) mg/L、(280.16±14.54) ng/L비(354.64±11.32) ng/L、(187.2±14.2)μmol/L비(225.4±12.7)μmol/L],차이유통계학의의(P＜0.05).수방180d량조균미발생엄중약물불량반응,B조총적심혈관사건발생솔저우A조[7.7％(3/39)비25.6％(10/39)],차이유통계학의의(P＜0.05).결론 강화강지경능강저ACS합병당뇨병노년환자PCI술후염성인자수평,감소심혈관사건,병구유흔호적안전성.
Objective To assess the effects of fluvastatin retard tablets on the elder patients of acute coronary syndrome(ACS) complicated with diabetes mellitus(DM) undergoing percutaneous coronary intervention (PCI) and the safety of drugs.Methods From December 2009 to December 2011,78 elderly patients (age≥65 years) of ACS complicated with DM who underwent PCI were enrolled in this study.They were all treated by drug elution stents.They were divided into group A(fluvastatin retard tablets 80 mg/d) and group B (fluvastatin retard tablets 160 mg/d) with 39 cases each by random digits table method.The plasma levels of high sensitivity C reactive protein (hs-CRP),matrix metalloproteinase proteinase 9 (MMP-9),monocyte chemoattractant protein 1 (MCP-1) and lipid levels were measured before and after treatment of 24 h,7 d and 180 d.All the patients were followed up for 180 d,and the adverse reaction of drug and the incidence of cardiovascular event were detected.Results Blood lipid levels had no significant changes in the two groups before and after treatment (P ＞ 0.05).The plasma levels of hs-CRP,MCP-1,MMP-9 were higher after treatment of 24 h than those before treatment in two groups [group A:(12.14 ± 2.71)mg/L vs.(8.76 ±2.25) mg/L,(491.75 ± 19.29) ng/L vs.(440.56 ± 13.15) ng/L,(449.6 ±11.8) μmol/L vs.(353.8 ± 16.0) μ mol/L;group B:(11.39 ± 2.38) mg/L vs.(9.30 ± 1.99) mg/L,(488.56 ± 17.61) ng/L vs.(436.06 ± 15.36) ng/L,(444.9 ± 19.1) μ mol/L vs.(349.8 ± 13.6) μmol/L],and there were significant differences (P ＜ 0.05).The plasma levels of hs-CRP,MCP-1,MMP-9 decreased significantly after treatment of 7,180 d compared with that after treatment of 24 h in two groups (P ＜ 0.05).Compared with those in group A,the plasma levels of hs-CRP,MCP-1,MMP-9 decreased even lower in group B[after 7 d:(4.51 ±1.16) mg/L vs.(5.43 ± 1.44) mg/L,(306.06 ± 18.49) ng/L vs.(384.64 ± 13.23) ng/L,(206.2 ± 16.8)μ mol/L vs.(263.4 ± 15.4)μ mol/L;after 180 d:(4.23 ± 1.08) mg/L vs.(4.68 ± 1.46) mg/L,(280.16 ± 14.54) ng/L vs.(354.64 ± 11.32) ng/L,(187.2 ± 14.2)μ mol/L vs.(225.4 ± 12.7) μ mol/L],and there were significant differences (P ＜ 0.05).After followed up for 180 d,there was no serious adverse reaction in two groups,and the total incidence of cardiovascular event in group B was lower than that in group A [7.7％(3/39) vs.25.6％ (10/39)],and there was significant difference (P ＜ 0.05).Conclusion Intensive lipid lowering therapy can reduce the level of inflammatory factors and cardiovascular event of the elder patients of ACS complicated with DM undergoing PCI and has good security.
