阿托伐他汀对急性冠脉综合征行PCI术后疗效及炎症因子的影响

目的探讨两种常规剂量阿托伐他汀对急性冠脉综合征(ACS)行经皮冠状动脉介入术(PCI)患者的疗效及炎症因子的影响。方法行PCI术的ACS患者102例随机分为A组(阿托伐他汀钙10 mg)和B组(阿托伐他汀钙20 mg)。比较2组患者PCI手术前后血脂[总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)]和炎症因子[超敏C反应蛋白(hsCRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]水平,观察术后30、180 d的主要心脏不良事件发生情况。结果 PCI术后,2组TC、TG、LDL-C与术前比较,差异均有统计学意义(P0.05)。2组术前、术后24 h血清TNF-α、IL-6、hs-CRP比较,差异均无统计学意义(P0.05);术后7、30 d比较,差异均有统计学意义(P0.05)。2组主要心脏不良事件发生率比较无显著差异(P0.05)。结论两种剂量的阿托伐他汀治疗ACS患者行PCI均安全有效,均能明显降低术后炎症因子水平。     

阿托伐他汀联合氯吡格雷治疗急性冠脉综合征的临床疗效及安全性

将2013年6月~2014年6月60例急性冠脉综合征病例均分为两组,均给予常规药物治疗,对照组另服用氯吡格雷,观察组则采用氯吡格雷与阿托伐他汀治疗,评估两组疗效并记录用药不良反应。结果观察组患者的治疗总有效率为96.7%,明显高于对照组的73.3%,组间差异具有统计学意义(P<0.05)。治疗后,观察组患者的血脂水平较治疗前和对照组有明显改善(P<0.05)。治疗期间两组均未出现明显药物相关不良反应。阿托伐他汀与氯吡格雷联合治疗急性冠脉综合征患者效果显著,可缓解炎症反应并有效调脂,进而延缓动脉硬化进展,安全性高,值得推广应用。     

阿托伐他汀与氯吡格雷对急性冠状动脉综合征患者血小板聚集率的影响

目的 探讨阿托伐他汀和氯吡格雷对急性冠状动脉综合征（ACS）患者血小板聚集率的影响.方法 选择66例ACS患者作为ACS组,25例健康志愿者作为对照组.ACS组患者在常规药物治疗基础上均予阿司匹林（100 mg/d）、氯吡格雷（75 mg/d）和阿托伐他汀（20 mg/d）治疗.对照组志愿者均予阿司匹林肠溶片、氯吡格雷和阿托伐他汀口服,药品来源、剂量与ACS组相同.采用流式细胞仪测定上述受试者的血小板聚集率.结果 对照组志愿者分别采用双联抗血小板联合阿托伐他汀治疗以及双联抗血小板治疗,血小板聚集率分别为（44.27±16.37）%、（47.61±16.67）%,二者差异无统计学意义（P〉0.05）.ACS组患者采用上述2种方法治疗,血小板聚集率分别为（47.70±15.07）%、（47.03±15.45）%,二者差异无统计学意义（P〉0.05）.结论 氯吡格雷与阿托伐他汀联合治疗不影响氯吡格雷的抗血小板作用,二者无相互作用.     

不同剂量阿托伐他汀对急性冠脉综合征患者介入治疗围术期疗效及安全性的观察

目的:探讨国人急性冠脉综合征(ACS)患者经皮冠脉介入(PCI)治疗围术期40 mg阿托伐他汀强化治疗的疗效及安全性.方法:采用随机对照研究方法,100例ACS患者随机分为A、B两组.A组50例给予阿托伐他汀20 mg/d,B组50例给予阿托伐他汀40 mg/d.于PCI 术前、术后24 h测定肌钙蛋白I(cTnI);PCI术前、术后5 d、术后30 d测定肌酸激酶(CK)、丙氨酸氨基转移酶(ALT)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC).观察ACS患者随访1个月期间主要心血管事件的发生情况.结果:(1)两组PCI术后24 h cTnI均显著升高(P ＜ 0.01),A组较B组升高幅度差异有统计学意义(P ＜ 0.05).(2)两组在用药后5 d及30 d LDL-C和TC均显著下降(P ＜ 0.01),40 mg组下降幅度更加显著且30 d LDL-C达标率(即LDL-C≤1.8 mmol/L比例)更高(24% vs 66%,P ＜ 0.01).(3)A组30 d主要心血管事件(心力衰竭2例)较A组(再发心肌梗死1例、心力衰竭5例、再发心绞痛需住院治疗3例共9例)显著降低(P ＜ 0.05).(4)两组药物副作用差异无显著性(P ＞ 0.05).结论:ACS患者PCI围手术期阿托伐他汀40 mg/d能显著降低LDL-C、TC、cTnI水平,提高30 d LDL-C达标率,降低围手术期主要心血管事件发生率.     

瑞舒伐他汀与阿托伐他汀对冠脉介入术后肾功能的影响

目的 探讨瑞舒伐他汀与阿托伐他汀对冠脉介入术后肾功能的影响.方法 入选2012年1月至2012年12月在北京电力医院接受冠脉造影和（或）冠脉介入治疗患者100例,术前被随机分为2组,一组（瑞舒伐他汀组）术前开始服用瑞舒伐他汀10 mg每晚1次,术后服用10 mg每晚一次维持,共入组50例;另一组（阿托伐他汀组）术前开始服用阿托伐他汀20 mg,术后服用20 mg每晚一次维持,共入组50例,观察术后48小时的估算肾小球滤过率（estimated GFR）.结果 2组间比较,瑞舒伐他汀与阿托伐他汀对行介入后患者肾功能影响无明显差异,P＞0.05.结论 瑞舒伐他汀和阿托伐他汀均可提高肾小球滤过率,且两药对改善肾小球滤过率的作用没有显著差异,在eGFR＞60 ml/min/1.73 m2患者中介入前使用瑞舒伐他汀与阿托伐他汀是安全、有效的,值得在临床推广应用.     

氯吡格雷联合阿司匹林对急性冠脉综合征PCI术后血小板聚集功能及预后的影响

目的观察氯吡格雷联合阿司匹林对急性冠脉综合征（ACS）并冠状动脉支架置人术（PCI）后患者血小板聚集功能及预后的影响。方法选择100例ACS并PCI术后患者随机分为两组,所有患者PCI术后常规给予阿司匹林、皮下注射低分子肝素钙及对症治疗,联合组50例加用氯比格雷75mg,1次／d;对照组50例加用安慰剂。两组疗程均为12个月。观察两组在30d内不同时问段血小板聚集率及12个月内血管再闭塞事件的发生情况。结果服药后30d内2组不同时间段血小板聚集率较治疗前均逐渐降低,联合组不同时间段血小板聚集率均显著低于对照组（P均〈0．05）;服药后12个月内联合组死亡率显著低于对照组（P〈0．05）;联合组血管再闭塞事件发生率显著低于对照组（P〈0．05）。两组均未发生严重的不良反应,两组不良反应发生率差异无统计学意义。结论氯吡格雷联合阿司匹林抑制血小板聚集的功能显著强于单用阿司匹林,能显著降低PCI术后死亡率,减少血管再闭塞事件,且不增加患者出血事件的发生。     

瑞舒伐他汀对急性冠脉综合征行PCI患者的影响

目的:观察瑞舒伐他汀对经皮冠状动脉介入治疗(PCI)的急性冠脉综合征患者心功能的影响。方法:选取我院收治的66例急性冠脉综合征患者为研究对象,随机分为观察组和对照组各33例。两组入院后均行PCI手术治疗,对照组术前给予抗血小板聚集等常规治疗,观察组在对照组治疗基础上予瑞舒伐他汀强化治疗,对比两组治疗前后心功能变化、心肌损伤及心脏不良事件发生情况。结果:两组治疗后LVEF、E/A水平明显高于治疗前,LVSD、LVDD水平明显低于治疗前,差异均有统计学意义(P0.05);观察组治疗后LVEF、E/A水平高于对照组,LVSD、LVDD水平低于对照组,差异均有统计学意义(P0.05)。两组治疗前CK-MB、cTnⅠ水平比较,差异无统计学意义(P0.05);治疗后,观察组CK-MB、cTnⅠ水平明显低于对照组(P0.05)。观察组不良心脏事件发生率为6.06%,明显低于对照组的18.18%,差异有统计学意义(P0.05)。结论:瑞舒伐他汀用于急性冠脉综合征患者PCI手术前后的治疗效果理想,可减轻对患者心功能、心肌的损伤,减少术后心脏不良事件的发生。     

PCI术后瑞舒伐他汀钙片联合替格瑞洛对急性冠脉综合征患者心功能、心肌损伤标志物及hs-CRP、Hcy的影响

目的 探讨急性冠脉综合征(ACS)患者经皮冠状动脉介入术(PCI)后瑞舒伐他汀片加替格瑞洛对其心功能、心肌损伤标志物和超敏C反应蛋白(hs-CRP)及同型半胱氨酸(Hcy)的影响。方法 前瞻性选取2018年6月至2019年6月在内江市第一人民医院行PCI治疗的ACS患者,应用随机数字表法分为观察组(n=45)和对照组(n=45)。对照组给予瑞舒伐他汀钙片和氯吡格雷治疗,观察组给予瑞舒伐他汀钙片和替格瑞洛治疗,两组均连续用药6个月。比较两组治疗前后左室射血分数(LVEF)、左室收缩末内径(LVESD)、左室舒张末内径(LVEDD)等心功能指标水平;心肌肌钙蛋白I(c Tn I)、血清肌红蛋白(MB)和α-羟丁酸脱氢酶(α-HBDH)等心肌损伤标志物达峰时间;治疗前后hsCRP及Hcy水平。记录两组心血管不良事件(MACE)及药物相关不良反应。结果 治疗后,观察组LVEF为(46.14±6.62)%,高于对照组[(38.72±5.94)%],LVESD、LVEDD为(38.70±5.32)、(50.25±6.32) mm,低于对照组[(44.20±6.05)、(56.20±5.68) mm...     

冠状动脉介入治疗后应用氯吡格雷治疗的患者血小板活化情况

目的探讨冠状动脉介入治疗(PCI)后,患者应用氯吡格雷作为抗血小板药物口服治疗,观察血小板活化的变化情况。方法采用流式细胞术(FCM)分别对PCI患者和健康体检人群血小板GPⅡb/Ⅲa进行检测,同时观察PCI患者应用氯吡格雷治疗前、后血小板GPⅡb/Ⅲa水平的变化。结果实验组入选时与健康对照组进行比较,实验组入选时GPⅡb/Ⅲa的水平较健康对照组明显升高,两组血小板GPⅡb/Ⅲa水平差异有统计学意义(P<0.05)。用药7d后其GPⅡb/Ⅲa水平较入选时明显下降,两组血小板GPⅡb/Ⅲa水平差异有统计学意义(P<0.05)。而健康对照组与实验组用药7d后进行比较,两组血小板GPⅡb/Ⅲa水平差异无统计学意义(P>0.05)。结论 PCI后应用氯吡格雷治疗患者血小板活化水平大部分都有明显下降,但仍有少部分患者没有明显下降,推测可能与血小板抵抗有关。     

Prasugrel in acute coronary syndrome patients undergoing percutaneous coronary intervention

Currently, dual antiplatelet therapy with aspirin and clopidogrel represents the key treatment strategy for the prevention of ischemic events in patients with acute coronary syndrome (ACS) and/or undergoing percutaneous coronary intervention (PCI). However, there is a broad inter-individual response variability to such treatment strategy, and a considerable number of patients persist with inadequate platelet inhibition, which has been associated with an increased risk of ischemic events. Overall, these findings underscore the need for novel antiplatelet agents able to achieve greater platelet inhibition; this can potentially reduce ischemic event rates. Prasugrel (CS-747; LY 640315), a novel third-generation oral thienopyridine, is a specific, irreversible antagonist of the platelet adenosine diphosphate P2Y₁₂ receptor. Laboratory studies have shown prasugrel to be associated with more prompt, potent and predictable degrees of platelet inhibition compared with clopidogrel. In a large-scale clinical study, which was comprised of high-risk ACS patients undergoing PCI, prasugrel was shown to significantly reduce the short- and long-term risk of ischemic events, including stent thrombosis. However, such significant reduction in ischemic events occurred at the expense of a higher risk of bleeding. Recent clinical trial data analyses have led to a better understanding of the efficacy and safety of prasugrel. This article reviews the currently available data regarding the efficacy and safety of prasugrel in ACS patients.     

Microvesicles from patients with acute coronary syndrome enhance platelet aggregation

Abstract

Microvesicles (MVs) released from leukocytes, platelets and endothelial cells are elevated in patients with acute coronary syndrome (ACS). In the present study, we assessed the potential pro-aggregatory properties of MVs obtained from ACS patients. Thus, we divided the patients into two groups based on clopidogrel-responsiveness, i.e. high on-treatment platelet reactivity (HPR; n?=?16), and low or normal on-treatment platelet reactivity (non-HPR; n?=?14), respectively. MVs from patients were obtained by high-speed centrifugation, and the pro-aggregatory effect of MVs added to fresh isolated platelets from healthy subjects were analyzed by 96-well microplate aggregometry. MVs from HPR patients significantly enhanced spontaneous platelet aggregation around two times more than MVs from non-HPR patients. The pro-aggregatory effect of three out of four MV phenotypes correlated to MV-concentrations as determined by flow cytometry. Furthermore, MVs from patients with diabetes mellitus (n?=?9) had a stronger pro-aggregatory effect compared to MVs from those without diabetes (n?=?21; p?=?.025 between groups). In conclusion, MVs from ACS patients with clopidogrel non-responsiveness enhance platelet aggregation, as do MVs from ACS patients with diabetes. Thus, MVs from patients with hyperreactive platelets boost platelet aggregation. Blocking MV-formation may reduce platelet hyperreactivity.     

评分对高龄急性冠状动脉综合征患者介入治疗预后的评估价值

目的：评价Barthel评分应用于高龄急性冠状动脉综合征患者冠脉介入治疗的意义。方法：选择181例75岁以上因急性冠状动脉综合征行冠脉介入治疗的患者。根据Barthel评分,将其分成3组：＜70分组（n=62）、≥70～90分组（n=72）及≥90分组（n=47）。比较3组患者住院后1个月内的临床转归。结果：与≥90分组相比,＜70分组患者年龄较大、女性比例更高、入院时收缩压较低、白细胞计数更多、既往消化性溃疡比例较低、 ST段抬高型心肌梗死比例更高、进行急诊介入治疗的比例更高,差异均有统计学意义（P<0.05)。与≥90分组相比,＜70分组术后左心室射血分数较低、脑钠肽前体（pro- BNP）水平更高、消化道出血比例更高、住院时间更长,差异均有统计学意义（P<0.05)。≥70~90分组和≥90分组上述指标差异均无统计学意义。结论：罹患急性冠状动脉综合征且Barthel评分小于70分的高龄患者住院后1个月内临床转归不佳;这类患者进行冠脉介入治疗时,应慎重权衡风险与获益。     

伴缺血性脑卒中史急性冠脉综合征患者PCI术后疗效的影响因素分析

目的 分析伴缺血性脑卒中史急性冠脉综合征(ACS)患者经皮冠状动脉介入(PCI)术后疗效的影响因素.方法 选取我院2016年10月至2018年10月收治的伴缺血性脑卒中史的ACS患者78例,均接受PCI术治疗.术后随访1年,根据随访情况将研究对象分为疗效良好组和疗效不佳组,分析影响患者PCI术后疗效的相关因素.结果 门...     

阿托伐他汀对急性冠状动脉综合征患者血清hs-CRP水平的影响

目的探讨不同剂量阿托伐他汀治疗对急性冠状动脉综合征(ACS)患者血清高敏C反应蛋白(hs-CRP)的影响。方法选择广州军区武汉总医院2010年5月至2012年5月收治的122例ACS患者,将其随机分为阿托伐他汀强化组(40mg/d,41例)和阿托伐他汀治疗组(20mg/d,41例),对照组(常规硝酸酯类、血管紧张素转化酶抑制剂或β受体阻滞剂药物治疗,40例),分别在入院24h内及2周后测定3组患者血清hs-CRP水平,并进行比较。结果治疗2周后,3组患者血清hs-CRP水平较治疗前明显降低(P<0.05),阿托伐他汀治疗组hs-CRP水平较对照组明显降低(P<0.05),阿托伐他汀强化组hs-CRP水平较阿托伐他汀治疗组及对照组显著降低(P<0.05)。结论阿托伐他汀可以减少ACS患者动脉粥样硬化斑块的炎性反应,大剂量阿托伐他汀较常规剂量更能降低ACS患者的hs-CRP水平。     

阿托伐他汀对急性冠状动脉综合征患者PCI术后炎症因子的影响

目的 研究阿托伐他汀负荷量治疗对ACS患者急诊经皮冠状动脉介入治疗(PCI)术后炎症因子水平的影响.方法 入选64例ACS患者随机分为阿托伐他汀常规量组和负荷量组.常规量组入院后30分钟内及术后每晚服阿托伐他汀10 mg,负荷量组入院后30分钟内服阿托伐他汀80 mg,术后连续3天服80 mg,后改为每晚10 mg,共观察14天.两组术前、术后3天、7天、14天分别抽血查高敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、血浆纤溶酶原激活剂抑制物(PAI-1)和P选择素水平.结果 第14天时阿托伐他汀负荷量组血清细胞因子水平显著低于常规量组,两组分别是hs-CRP(3.37±0.12)mg/L vs(5.54±0.10)mg/L、IL-6(2.96±0.18)ng/L vs(5.28±0.24)ng/L和PAI-1(6.57±0.24)ng/L vs(7.33±0.57)ng/L,均P＜0.05.起始3天负荷量较常规量对血脂水平无更大影响.结论 阿托伐他汀负荷量较常规量能更显著抑制PCI术后的炎症反应,降低血清hs-CRP、IL-6、PAI-和P选择素水平.     

Prognostic value of systemic inflammatory response index in patients with acute coronary syndrome undergoing percutaneous coronary intervention

BackgroundThe systemic inflammatory response index (SIRI) is a novel inflammatory biomarker in many diseases.ObjectivesThe aim of this study was to examine the association between SIRI and adverse events in patients with the acute coronary syndrome (ACS) undergoing percutaneous coronary intervention.MethodsA total of 1724 patients with ACS enrolled from June 2016 to November 2017 at a single centre were included in this study, and SIRI was calculated for each patient. The primary endpoint was the composite of major adverse cardiovascular events (MACE), including overall death, non-fatal myocardial infarction, non-fatal stroke, and unplanned repeat revascularization.ResultsDuring a median follow-up of 927 days, 355 patients had MACE. Multivariate Cox analysis showed that SIRI was significantly associated with MACE (hazard ratio: 1.127, 95% confidence interval: 1.034–1.229 p = .007). The results were consistent in multiple sensitivity analyses. The addition of SIRI had an incremental effect on the predictive ability of the Global Registry of Acute Coronary Events risk score for MACE (integrated discrimination improvement: 0.007, p = .040; net reclassification improvement: 0.175, p = .020; likelihood ratio test: p < .001). The restricted cubic spline showed a monotonic increase with a greater SIRI value for MACE (p < .001).ConclusionSIRI was an independent risk factor for MACE and provided incremental prognostic information in patients with ACS undergoing percutaneous coronary intervention.

KEY MESSAGES

• The SIRI is a strong and independent risk factor for adverse outcomes in patients with ACS undergoing percutaneous coronary intervention.
• Higher SIRI is associated with a more severe disease status.
• The SIRI could increase the prognostic value of the GRACE risk score.