阿托伐他汀对慢性阻塞性肺疾病合并肺动脉高压患者的影响

目的:评价阿托伐他汀对慢性阻塞性肺疾病(COPD)合并慢性肺源性心脏病(简称肺心病)患者肺动脉高压(PH)的影响。方法:55例COPD合并慢性肺心病、PH患者随机分为2组:阿托伐他汀组(AL组,27例)和常规治疗组(28例)。2组患者均接受常规治疗,阿托伐他汀组口服阿托伐他汀,20mg/d。分别观察阿托伐他汀组及常规治疗组治疗前、治疗后6个月血浆中一氧化氮(nitric oxide,NO)、内皮素I(endothelin-1,ET-1)、超声心动图变化。结果:阿托伐他汀组治疗6个月后ET-1、PH较治疗前和常规治疗组治疗6个月时明显下降(P<0.05)、内源性一氧化氮(NO)明显升高(P<0.05)。常规治疗组治疗前、治疗后6个月上述指标比较差异无统计学意义(P>0.05)。结论:阿托伐他汀可调节NO及ET-1的分泌,有效降低PH。     

阿托伐他汀对肺心病患者血清中8-iso-PG水平的影响

目的探讨阿托伐他汀对慢性肺源性心脏病患者血清中8-异前列腺素的影响及可能机制。方法选择南通大学第二附属医院急诊科和呼吸科住院的45例慢性肺源性心脏病患者,随机分成阿托伐他汀治疗组(23例)和常规治疗组(22例),常规治疗组予吸氧、抗感染、止咳化痰、平喘等对症治疗,阿托伐他汀治疗组在此基础上加用阿托伐他汀20 mg口服,每晚一次,疗程6个月。分别于治疗前后行超声心动图、6分钟步行距离(6MWD)、动脉血气分析检查,同步收集血清标本,采用酶联免疫吸附方法(ELISA)方法检测血清中8-异前列腺素(8-iso-PG)。比较阿托伐他汀治疗组与常规治疗组治疗前后的肺动脉压力、动脉血气分析、6MWD、血清中8-iso-PG水平,分析临床指标和各个检测指标的相关性。结果①治疗前,两组血清中8-isoPG水平无明显差异(P0.05)。在治疗后,两组血清中8-iso-PG水平较前下降,P0.05,但阿托伐他汀治疗组较常规治疗组降低更明显(P0.05)。②在治疗后,阿托伐他汀治疗组肺动脉压(PASP)较前明显降低,动脉血氧分压(PaO2)、6-MWD较前明显增高;而常规治疗组无明显改变,P均0.05,两组比较有显著差异(P0.05)。结论阿托伐他汀能降低慢性肺源性心脏病患者肺动脉压力,提高动脉血氧分压,改善活动耐力,其机制可能与抑制炎症反应和氧化应激有关。     

阿托伐他汀对慢性肺心病缓解期患者肺功能及炎性因子的影响

目的 探讨阿托伐他汀对慢性肺心病缓（CPHD）解期患者肺功能及肺血管炎性因子的影响.方法 随机将118例CPHD缓解期患者分为对照组和观察组,每组均为59例,对照组采用常规治疗,观察组在常规治疗基础上加用阿托伐他汀.比较两组的临床疗效,治疗前后肺功能指标和肺血管炎性因子的变化.结果 观察组显效率和总有效分别达到49.15%和81.36%,显著高于对照组（P〈0.05）;治疗后观察组PAP、达到（44.61±6.80）mmHg,显著低于治疗前和对照组（P〈0.05）,FEV1、FEV1/FVC（%）分别为（0.93±0.19）L和（65.03±6.02）%,显著高于治疗前和对照组（P〈0.05）,两组FVC差异无显著性（P〉0.05）;治疗后观察组ET-1、IL-8和hs-CRP水平分别为（62.03±5.46）pg/ml、（51.54±7.66）ng/L和（1.57±0.40）mg/L,显著低于对照组治疗后水平（P〈0.05）.结论 常规治疗基础上联用阿托伐他汀可显著改善慢性肺心病缓解期患者的肺功能和临床症状,其机制可能与阿托伐他汀对肺血管炎性因子抑制作用有关.     

氟伐他汀对老年慢性肺心病患者心脏Tei指数的影响

目的 评价氟伐他汀对老年慢性肺源性心脏病(肺心病)患者心功能的影响.方法 45例老年合并慢性肺心病患者随机分为两组.氟伐他汀组(23例)和常规治疗组(22例).两组患者均接受常规治疗,氟伐他汀组口服氟伐他汀40 mg/d.观察两组治疗前、治疗后6个月血浆中脑钠肽(BNP)、肺动脉压和心脏Tei指数变化.结果 氟伐他汀组治疗6个月后BNP、Tei指数、肺动脉压较治疗前和常规治疗组治疗6个月时明显下降(P<0.05);常规治疗组治疗前、治疗后6个月上述指标比较差异无统计学意义(P>0.05).结论 氟伐他汀可调节BNP的分泌,有效降低肺动脉压及改善心脏Tei指数.     

阿托伐他汀对2型糖尿病患者血糖和血浆ET及hs-CRP的影响

目的 探讨阿托伐他汀对2型糖尿病患者血糖、血浆内皮素(ET)和高敏C反应蛋白(hs-CRP)的影响.方法 60例患者随机分为治疗组和对照组各30例.检测两组治疗前后ET和hs-CRP.结果 治疗组治疗2周、4周后ET和hs-CRP较治疗前明显下降(P<0.05或P<0.01),但对照组治疗前后比较各指标均无统计学意义(P>0.05).结论 阿托伐他汀能够降低2型糖尿病患者血浆ET和hs-CRP,抑制血管内皮的炎症反应,延缓动脉硬化的进程.     

阿托伐他汀对吸烟伴慢性肺源性心脏病患者近期心肺事件的影响

目的 评价阿托伐他汀对吸烟伴慢性肺源性心脏病患者近期心肺事件的影响.方法 55例吸烟伴慢性阻塞性肺疾病(COPD)合并慢性肺心病、肺高压患者随机分为阿托伐他汀治疗组(n＝27)和常规治疗组(n＝28).两组患者均接受常规治疗,阿托伐他汀治疗组口服阿托伐他汀(20 mg/d).分别观察阿托伐他汀治疗组及常规治疗组治疗前、治疗后6个月肺功能、超声心动图和6 min步行距离的变化,并随访患者的近期心肺事件.结果 阿托伐他汀治疗组治疗6个月后肺动脉压较治疗前和同期常规治疗组同期明显下降(P<0.05)、6 min步行距离明显增加(P<0.05),第1秒用力呼气容积(FEV1)、FEV1/用力肺活量(FVC)等肺功能指标比常规组治疗6月后有明显改善(P<0.05);常规治疗组治疗前、治疗后6个月上述指标比较差异无统计学意义(P>0.05);阿托伐他汀治疗组近期心肺事件发生率明显低于常规治疗组(P<0.05).结论 阿托伐他汀可以改善吸烟伴慢性肺源性心脏病患者生活质量及肺功能、降低肺动脉压,改善患者的近期预后.     

阿托伐他汀对慢性阻塞性肺疾病合并肺动脉高压患者慢性炎症反应的影响

目的 探讨阿托伐他汀对慢性阻塞性肺疾病(COPD)合并肺动脉高压(PH)患者慢性炎症反应的影响及其安全性.方法 选择COPD合并PH患者78例,随机分为阿托伐他汀组和常规组,两组各39例.常规组采用常规治疗措施治疗,阿托伐他汀组在常规组基础上加用阿托伐他汀.比较两组患者治疗前、治疗后3个月时炎性因子、一氧化氮(NO)、内皮素-1(ET-1)、肺动脉平均压(PAPm)、肺动脉收缩压(PAPs)及肺功能指标变化情况.结果 两组患者治疗后白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、C反应蛋白(CRP)、ET-1、肺动脉平均压(PAPm)、肺动脉收缩压(PAPs)水平均较治疗前明显降低(P＜0.05),但阿托伐他汀组降低程度更明显(P ＜0.05);NO、FEV1％、FVC较治疗前明显升高(P＜0.05),而阿托伐他汀组升高程度更明显(P＜0.05).阿托伐他汀组服药期间无明显不良反应发生.结论 阿托伐他汀可降低COPD合并PH患者的各种细胞炎性因子,减轻炎症反应,调节NO与ET-1的平衡,降低PH,同时减少肺损伤,改善肺功能,疗效安全可靠,可作为治疗COPD合并PH的有效药物.     

阿托伐他汀对继发性肺动脉高压的影响

目的探讨阿托伐他汀对继发性肺动脉高压的影响。方法选取2009年6月—2010年6月我院收治的经超声心电图诊断的继发性肺动脉高压患者60例,将其随机分成研究组和对照组,各30例。对照组常规给予抗心力衰竭、改善肺动脉压力治疗;研究组在对照组治疗基础上加用阿托伐他汀20 mg,持续治疗2个月。记录两组患者治疗前后肺动脉压、左室射血分数(LVEF)及6分钟步行距离。结果治疗后研究组肺动脉压力低于对照组(P0.05);两组LVEF和6分钟步行距离比较,差异均无统计学意义(P0.05)。结论联合阿托伐他汀治疗继发性肺动脉高压,能够更好地降低肺动脉压。     

不同剂量阿托伐他汀对ACS患者血浆妊娠相关蛋白A和hs-CRP的影响

目的探讨不同剂量阿托伐他汀对ACS病人妊娠相关蛋白A(PAPP-A)和高敏C反应蛋白(hs-CRP)水平的影响。方法 104例有临床症状或冠脉造影结果证实冠心病病人,根据阿托伐他汀剂量的不同分为10 mg组、20 mg组、40 mg组,测定基线和第1周及第4周PAPP-A和hs-CRP水平。结果 73例急性冠脉综合征病人血浆PAPP-A、hs-CRP水平高于稳定心绞痛病人(P<0.05)。与用药前比较,10 mg组、20 mg组PAPP-A和hs-CRP差异无统计学意义,而40 mg组在第4周时降低PAPP-A水平有统计学意义(P<0.05)。结论 PAPP-A在ACS中显著升高,高剂量他汀能降低它的水平,而低剂量的他汀无此效应。     

不同剂量阿托伐他汀对稳定型心绞痛患者循环血中内皮祖细胞的影响

目的观察不同剂量的阿托伐他汀对稳定型心绞痛患者循环血中内皮祖细胞数量的影响。方法选取稳定型心绞痛患者84例,分别给予不同剂量的阿托伐他汀10 mg/d、20 mg/d、40 mg/d或80 mg/d治疗共4周。用免疫荧光法检测各组患者用药前后循环血中内皮祖细胞的数量。结果不同剂量的阿托伐他汀应用后内皮祖细胞的数量均较用药前显著性增加(P0.05),并且内皮祖细胞的数量在40 mg/d组最高,与10 mg/d及20 mg/d组相比有显著性差异(P0.05),80 mg/d组较40 mg/d组略有下降,但无统计学差异(P0.05)。结论阿托伐他汀具有剂量依赖性地促进冠心病患者循环血中内皮祖细胞数量增加的作用。     

Effects of plasma adiponectin levels on the number and function of endothelial progenitor cells in patients with coronary artery disease.

BACKGROUND: It is not known whether plasma adiponectin levels are associated with the number and function of endothelial progenitor cells (EPCs) in patients with coronary artery disease (CAD). METHODS AND RESULTS: Plasma levels of adiponectin were measured in 70 patients undergoing coronary angiography. The numbers of colony-forming units (CFUs) of EPCs and senescent EPCs, determined by acidic beta-galactosidase staining, were counted. The angiogenic growth factors in the culture medium were also measured. There was a significant positive correlation between adiponectin level and CFUs (r=0.257, p<0.05) but not with the occurrence of senescent EPCs. Next, patients were divided into a high adiponectin group (high ADP: > or =6.17 microg/ml, n=36) and low adiponectin group (low ADP: <6.17 microg/ml, n=34). The number of diseased coronary arteries was less in the high ADP group than that in the low ADP patients (1.7+/-0.8 vs 2.1+/-0.7, p<0.05). No significant differences between the 2 groups were demonstrated in angiogenic growth factors secreted from EPCs. CONCLUSIONS: The results suggest that plasma adiponectin levels are associated with the number of EPCs in patients with CAD.     

内皮祖细胞在肺动脉高压的作用

内皮祖细胞是成熟血管内皮细胞的前体细胞,属于干细胞群体,其在血管再生与修复方面的应用越来越受到关注.肺动脉高压作为一种致死性很高的肺血管疾病,其发病与血管内皮损伤密切相关.目前的研究证实,内皮祖细胞在肺动脉高压血管内皮修复中具有重要作用,内皮祖细胞移植有可能成为临床治疗肺动脉高压的一种有效手段.     

Normal levels and function of endothelial progenitor cells in patients with psoriatic arthritis

Endothelial progenitor cells (EPCs) are a population of bone marrow derived cells which have been attributed with the ability to migrate into areas of tissue ischemia and to posses reparative qualities. EPCs have been shown to be decreased in level and function in various inflammatory disorders. Psoriasis and psoriatic arthritis are associated with an increase in cardiovascular morbidity. The aim of the study was to investigate the number of EPCs among patients suffering from psoriasis and psoriatic arthritis. Patients suffering from active psoriasis and psoriatic arthritis were recruited as well as healthy controls. Disease activity was assessed with the DAS-28, BASDAI and PASI scores. Peripheral blood mononuclear cells were isolated and EPC numbers evaluated by FACS analysis using the CD34/133 and CD34/KDR. No significant difference was found between numbers of EPCs between healthy controls, patients with psoriasis and psoriatic arthritis. A significant correlation was found between levels of VGEF and the BASDAI score. The results of the current study do not support a significant role for EPCs in the pathogenesis of psoriasis and psoriatic arthritis.     

脱氢野百合碱诱发肺动脉高压犬的循环内皮祖细胞数量和功能变化

目的 观察脱氢野百合碱(DHMC)诱发犬肺动脉高压形成前后循环内皮祖细胞数量和功能的变化.方法 10只Beagle犬经右心室注射DHMC诱导肺动脉高压(PAH).注射DHMC前、注射后6周采集静脉血,用流式细胞仪分析AC133和KDR检测双阳性的细胞数量.收集单个核细胞体外培养7 d后进行乙酰化低密度脂蛋白胆固醇(DiLDL)摄取和凝集素-Ⅰ(UEA-Ⅰ)结合反应,并进行体外血管生成试验.计量资料采用(-x)±s表示,采用配对t检验进行统计学分析.结果 10只Beagle犬注射DHMC后9只存活,1只于第2天死亡.注射DHMC后6周肺动脉平均压由(11.3±2.0)mm Hg(1 mm Hg=0.133 kPa)增高到(20.2±1.6)mm Hg(t=10.307,P＜0.01).PAH形成前后经流式细胞仪分析的ACl33和KDR双阳性细胞数量分别为(632.8±42.8)个/nil和(206.1±26.8)个/m1(t=25.361,P＜0.01);体外培养7 d的细胞中UEA-Ⅰ和DiLDL染色双阳性细胞数量分别为(41±6)个/200倍视野和(22±6)个/200倍视野(t=6.510,P＜0.01).体外成血管试验中形成的血管数为(21.1±2.8)支/200倍视野和(11.2±2.8)y./200倍视野(t=7.583,P＜0.01).结论 犬肺动脉高压形成后循环内皮祖细胞数最减少,成血管能力下降.     

Endothelial progenitor cells correlate with endothelial function in patients with coronary artery disease

Endothelial progenitor cells (EPC) predict morbidity and mortality in patients at cardiovascular risk.Patients with low EPC counts and impaired endothelial colony forming activity have a higher incidence for cardiovascular events compared to patients with high EPC counts and favorable colony forming activity. The pathophysiological basis for this finding may be an insufficient endothelial cell repair by EPC.We postulate that EPC influence coronary endothelial function which itself is relevant for the outcome of patients at cardiovascular risk. To test this hypothesis in humans, endothelial function was invasively assessed in 90 patients with coronary heart disease by quantitative coronary angiography during intracoronary acetylcholine infusion. Flow cytometry of mononuclear cells isolated from peripheral blood was performed to assess CD133(+) or CD34(+)/KDR(+) EPC. EPC function was assessed ex vivo by determination of endothelial colony forming units. Low EPC number as well as impaired endothelial colony forming activity correlated with severely impaired coronary endothelial function in univariate analysis. Multivariate analysis revealed that only the number of EPC predicts severe endothelial dysfunction independent of classical cardiovascular risk factors. Endothelial function closely correlates with the number of circulating EPC providing new mechanistic insights and options for risk assessment in patients with coronary heart disease.     

阿托伐他汀对急性冠脉综合征患者血清高敏C反应蛋白和妊娠相关血浆蛋白-A水平的影响

目的探讨阿托伐他汀干预对急性冠脉综合征(ACS)患者血清高敏C反应蛋白(hs-CRP)和妊娠相关血浆蛋白-A(PAPP-A)水平的影响。方法采用酶联免疫吸附法测定不稳定型心绞痛患者(UAP,n=37)、急性心肌梗死患者(AMI,n=24)、稳定型心绞痛患者(SAP,n=29)和健康体检者(n=32)的hs-CRP和PAPP-A水平。同时将ACS患者(包括UAP和AMI组,n=61)随机分为常规治疗组(n=30)和阿托伐他汀干预组(阿托伐他汀10mg/d,n=31),并于治疗前后分别测定血清hs-CRP和PAPP-A水平。结果(1)hs-CRP和PAPP-A水平在UAP组[(16.7±1.24)mg/L,(63.88±1.82)μg/L]、AMI组[(18.52±1.96)mg/L,(66.41±1.24)μg/L]比SAP组[(4.6±1.16)mg/L,(47.56±0.72)μg/L]、正常对照组[(3.2±0.88)mg/L,(45.17±1.28)μg/L]显著升高(P<0.05)。(2)2周后,阿托伐他汀干预组血清hs-CRP和PAPP-A水平较治疗前明显降低[hs-CRP(18.52±2.37)mg/Lvs.(3.58±1.33)mg/L;PAPP-A(67.83±2.15)μg/Lvs.(45.62±1.58)μg/L,P<0.05],且较常规治疗组治疗2周后亦有显著降低[hs-CRP(3.58±1.33)mg/Lvs.(5.23±1.98)mg/L;PAPP-A(45.62±1.58)μg/Lvs.(51.35±2.15)μg/L,P<0.05]。结论阿托伐他汀干预可以减少急性冠脉综合征患者动脉粥样硬化斑块的炎症反应,具有稳定斑块的作用。     

Effects of folic acid and N-acetylcysteine on plasma homocysteine levels and endothelial function in patients with coronary artery disease

OBJECTIVE: Hyperhomocysteinaemia is related with premature coronary artery disease and adverse cardiac events in patients with coronary artery disease (CAD). It is assumed that hyper-homocysteinaemia causes endothelial dysfunction. In this study, the effect of folic acid and oral N-acetylcysteine (NAC) therapies on plasma homocysteine levels and endothelial function were evaluated in hyperhomocysteinaemic patients with CAD. METHODS AND RESULTS: 60 patients were randomized to either folic acid 5 mg or NAC 600 mg or placebo daily for eight weeks. Brachial artery endothelial functions were studied by using high-resolution ultrasound and assessed by measuring endothelium-dependent dilation (EDD) and endothelium-independent dilation (NEDD). Folic acid and NAC therapies decreased plasma homocysteine (from 21.7 +/- 8.7 micromol/l to 12.5 +/- 2.5 micromol/l, P < 0.001; from 20.9 +/- 7.6 micromol/l to 15.6 +/- 4.3 micromol/l, P = 0.03, respectively), and increased EDD (6.7 +/- 6.1% P = 0.002, 4.4 +/- 2.6% P < 0.001, respectively) compared with placebo. There was no significant difference in improving EDD between the folic acid and the NAC group (6.7 +/- 6.1%, 4.4 +/- 2.6%, P = 0. 168). In the univariate analyses there was an inverse correlation between the post-treatment homocysteine level and the percent change in EDD with folic acid therapy (r= -0.490, P = 0.028), but there was no correlation with the NAC therapy (r = 0.259, P = 0.333) CONCLUSION: In patients with hyperhomocysteinaemic CAD, folic acid and NAC lowered plasma homocysteine levels and improved endothelial function.The effects of both treatments in improvement of EDD were similar.     

瑞舒伐他汀对老年稳定性冠心病患者外周血中血管内皮祖细胞的影响

目的通过观察老年稳定性冠心病患者应用瑞舒伐他汀或阿托伐他汀后,外周血中血脂水平及血管内皮祖细胞(endothelial progenitor cells,EPCs)频率的变化,探讨瑞舒伐他汀在治疗稳定性冠心病过程中的调脂及非调脂作用。方法选择稳定性冠心病患者60例,根据用药不同随机分为3组,每组20例:A组:瑞舒伐他汀10 mg/d;B组:阿托伐他汀20 mg/d;C组:安慰剂(淀粉)1片/d。4周后,全自动生化分析仪检测患者血脂水平,流式细胞仪检测患者外周血中EPCs(CD34~+、血管内皮生长因子受体~+)频率。结果治疗前,3组患者TC、TG、LDL-C、HDL-C水平及外周血中EPCs频率差异无统计学意义(P>0.05)。治疗4周后,与C组比较,A组和B组患者TC、TG、LDL-C水平均明显降低,差异有统计学意义(P<0.05);与C组比较,A组和B组患者外周血中EPCs频率明显升高,差异有统计学意义(P<0.05)。结论瑞舒伐他汀不仅可以有效降低老年稳定性冠心病患者TC、LDL-C及TG水平,还可以有效升高外周血中EPCs频率,同时发挥调脂及非调脂作用,对减少心血管事件的发生起着重要的作用。