瑞舒伐他汀钙对急性脑梗死患者血脂和血清超敏C反应蛋白的影响

目的：比较瑞舒伐他汀钙和辛伐他汀对急性脑梗死患者血脂的疗效,并对两组患者高敏C‐反应蛋白（hs‐CRP）水平对比分析。方法选取120例脑梗死合并高脂血症的患者,随机分为观察组和对照组各60例。分别予以瑞舒伐他汀钙、辛伐他汀治疗,用药4周后检测血清脂蛋白、hs‐CRP水平。结果观察组较对照组血清低密度脂蛋白、hs‐CRP显著降低（P＜0．05）。结论瑞舒伐他汀钙可降低急性脑梗死患者的血脂及hs‐CRP水平,对急性脑梗死具有较好的疗效。     

奥拉西坦联合瑞舒伐他汀对脑梗死患者血清超敏C反应蛋白、白细胞介素-1β、白细胞介素-6的影响

目的探讨奥拉西坦联合瑞舒伐他汀治疗脑梗死的临床疗效以及对患者血清超敏C反应蛋白(hs-CRP)、白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)的影响。方法选取100例脑梗死患者,随机分为观察组和对照组各50例。对照组采用常规治疗,观察组采用奥拉西坦联合瑞舒伐他汀,观察2组患者的临床疗效,比较治疗前后hs-CRP、IL-1β、IL-6水平。结果观察组治疗总有效率显著高于对照组(P0.05)。治疗后,2组hs-CRP、IL-1β、IL-6水平均显著改善(P0.05),且观察组显著优于对照组(P0.05)。结论采用奥拉西坦联合瑞舒伐他汀治疗脑梗死患者疗效确切,能够显著改善血清hs-CRP、IL-1β、IL-6水平。     

不同剂量瑞舒伐他汀对冠脉支架术后血清hs-CRP与PAPP-A水平的影响

目的观察不同剂量瑞舒伐他汀对冠心病(CHD)患者支架置入术后血清高敏C反应蛋白(hs-CRP)及妊娠相关蛋白A(PAPP-A)水平的影响。方法选择120例成功置入药物洗脱支架的CHD患者为研究对象,随机分为观察组和对照组,每组60例。观察组给予瑞舒伐他汀20mg/d,对照组给予瑞舒伐他汀5mg/d,2组患者其他药物应用情况无差异。于支架置入术后即刻和术后12周抽取外周血,观察血清hs-CRP和PAPP-A的变化。结果与术后即刻相比,术后12周观察组和对照组hs-CRP及PAPP-A水平均显著下降(P0.01),且观察组下降幅度显著大于对照组(P0.01)。结论与给予瑞舒伐他汀5mg相比,给予瑞舒伐他汀20mg可使行支架置入术的CHD患者炎性因子水平显著降低。     

瑞舒伐他汀对急性脑梗死患者的治疗机制

目的：探讨瑞舒伐他汀对急性脑梗死患者的治疗效果及作用机制。方法选择北京航天总医院2011年3月至2012年12月收治的110例急性脑梗死患者,随机分为观察组和对照组各55例。对照组患者给予常规治疗,主要包括保护脑细胞、控制血糖和血压、抗血小板聚集等;观察组患者在对照组的基础上给予瑞舒伐他汀治疗。连续治疗12周为1个疗程。记录比较两组患者治疗前、后血脂、血清超敏C-反应蛋白（hs-CRP）水平变化,并对患者进行神经功能缺损程度评分,评价疗效。结果治疗后对照组患者血脂水平无明显改变,观察组患者血脂水平明显下降,与对照组比较差异有统计学意义（P＜0．05）,两组hs-CRP均有下降,观察组患者hs-CRP水平低于对照组,差异有统计学意义（P＜0．05）,两组患者神经功能缺损评分均有下降,观察组低于对照组,差异有统计学意义（P＜0．05）,观察组总有效率高于对照组,差异有统计学意义（P＜0．05）。结论采用瑞舒伐他汀治疗急性脑梗死患者疗效值得肯定,这可能与其能够降低患者血脂和抗炎性反应治疗机制有关。     

瑞舒伐他汀对肥胖型2型糖尿病合并高脂血症患者高敏C反应蛋白及血脂的影响

目的观察瑞舒伐他汀对肥胖型2型糖尿病合并高脂血症患者血清高敏C反应蛋白（hs-CRP）及血脂水平的影响。方法将80例肥胖型2型糖尿病合并高脂血症患者随机分为观察组及对照组,每组40例。2组均按照2型糖尿病治疗指南标准给予常规降糖治疗,观察组在常规治疗基础上,给予10 mg.d-1的瑞舒伐他汀治疗。治疗6个月,检测2组治疗前后血清hs-CRP和血脂水平。结果观察组血清hs-CRP、LDL-C、TG、TC水平与治疗前相比明显降低,差异有统计学意义（P〈0.05）,血清HDL-C水平与治疗前相比升高,但差异无统计学意义（P〉0.05）;对照组治疗后血清hs-CRP水平降低,但与治疗前相比差异无统计学意义（P〉0.05）,血清LDL-C、HDL-C、TG、TC水平与治疗前相比差异无统计学意义（P〉0.05）。2组治疗后相比：观察组血清hs-CRP、LDL-C、TG及TC水平均明显低于对照组,差异有统计学意义（P〈0.05）;血清HDL-C水平与对照组相近,差异无统计学意义（P〉0.05）。结论瑞舒伐他汀可降低肥胖型2型糖尿病合并高脂血症患者超敏C反应蛋白及血脂水平。     

瑞舒伐他汀联合尼可地尔对冠心病患者PIC术后血管内皮功能及hs-CRP的影响

选取我院89例稳定性冠心病患者,随机分为对照组44例和观察组45例。对照组给予尼可地尔治疗,观察组行尼可地尔、瑞舒伐他汀联合治疗,观察比较两组肱动脉血流介导性舒张功能(FMD)、血清内皮素(ET)-1水平及hs-CRP水平。结果治疗后观察组FMD水平高于对照组,ET-1水平低于对照组,差异具有统计学意义(P<0.05);治疗后观察组血清hs-CRP水平低于对照组,差异具有统计学意义(P<0.05)。瑞舒伐他汀联合尼可地尔治疗稳定性冠心病,可有效改善患者血管内皮功能及血清超敏C反应蛋白水平。     

瑞舒伐他汀对急性脑梗死患者颈动脉内膜中层厚度及炎性反应的影响

目的观察瑞舒伐他汀对急性脑梗死患者颈动脉内膜中层厚度及炎性反应的影响。方法将入选的94例急性脑梗死患者随机分为治疗组48例和对照组46例。对照组用常规治疗方法,不服用他汀类药物;治疗组在对照组常规治疗的基础上加瑞舒伐他汀钙10 mg/次,每日1次口服。两组均连续治疗6个月。观察两组治疗前后的疗效、颈动脉内膜中层厚度(IMT)及超敏C-反应蛋白(hs-CRP)含量的变化情况。结果用药6个月后,治疗组的神经功能缺损评分较治疗前和对照组显著降低(P均<0.01);治疗组的总有效率显著高于对照组(P<0.05)。治疗组IMT、血清hs-CRP含量比治疗前及对照组均显著降低(P<0.05或P<0.01)。瑞舒伐他汀的不良反应轻微。结论瑞舒伐他汀能有效降低颈动脉内膜中层厚度及hs-CRP含量,减轻血管炎性反应,稳定和减轻颈动脉粥样硬化斑块,疗效明显,安全性好。     

阿托伐他汀和瑞舒伐他汀对2型糖尿病血脂和高敏C反应蛋白作用效果的比较

目的比较阿托伐他汀和瑞舒伐他汀对2型糖尿病血脂和高敏C反应蛋白作用效果的差异。方法随机入选年龄和性别匹配的2型糖尿病合并血脂异常患者64例,分为2组,每组32例。根据NCEP-ATPⅢ指南,分别服用阿托伐他汀(40～80mg)或者瑞舒伐他汀(10～40mg)3个月。比较两组间血脂和高敏C反应蛋白的水平差异。结果在2型糖尿病患者中,阿托伐他汀和瑞舒伐他汀都显著降低总胆固醇、低密度脂蛋白胆固醇、甘油三酯和高敏C反应蛋白水平(P<0.05),升高高密度脂蛋白胆固醇水平。此外,两组在降低甘油三酯和高敏C反应蛋白水平、升高高密度脂蛋白胆固醇水平上无差异。但是,瑞舒伐他汀更显著地降低了总胆固醇和低密度脂蛋白胆固醇水平。结论本研究显示瑞舒伐他汀在2型糖尿病患者中在降低总胆固醇和低密度脂蛋白胆固醇水平方面更有效。     

氨氯地平联合瑞舒伐他汀钙对老年急性脑梗死合并高血压患者CRP及D-二聚体的影响

目的探讨氨氯地平联合瑞舒伐他汀钙治疗老年急性脑梗死合并高血压的临床疗效。方法 80例急性脑梗死合并高血压患者随机分为观察组和对照组,每组40例。所有患者均给予阿司匹林片,在此基础上对照组给予苯磺酸氨氯地平片,观察组给予苯磺酸氨氯地平片加瑞舒伐他汀钙,2组疗程均为30 d。检测各组治疗前后NIHSS评分、斑块大小及颈动脉内中膜厚度(IMT),比较血压、脉压、血脂、C反应蛋白(CRP)及D-二聚体水平,观察各组不良反应发生情况。结果治疗后,2组NIHSS评分均较治疗前明显降低(P0.05);观察组治疗后NIHSS评分、斑块大小、IMT明显低于对照组;2组收缩压、舒张压、脉压均较治疗前明显降低,观察组血压减低更加明显(P0.05);观察组治疗后血脂水平明显低于治疗前和对照组(P0.05);2组血清CRP、D二聚体水平均较治疗前明显降低,观察组降低更加明显(P0.05)。2组不良发生情况无差异。结论氨氯地平联合瑞舒伐他汀钙可有效改善老年急性脑梗死合并高血压患者的不良反应少,值得临床推广使用。     

氟伐他汀与瑞舒伐他汀对冠心病患者的降脂疗效比较

选取我院2012年10月~2013年8月收治的200例冠心病患者,并随机将所有患者分成2组各100例,其中氟伐他汀组采取氟伐他汀进行治疗,瑞舒伐他汀组采取瑞舒伐他汀进行治疗。对比两组在治疗前后高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)以及总胆固醇(TC)、三酰甘油(TG)、超敏C反应蛋白(hs-CRP)的水平差别。结果在接受治疗半个月后,两组患者的LDL-C、TC、TG、hs-CRP均有所下降,而HDL-C均有升高,且两组均无不良反应发生,安全可靠,但瑞舒伐他汀对冠心病患者的降脂效果优于氟伐他汀组,且安全可靠,值得在临床上进一步推广。     

脑梗死患者血清脂蛋白（a）与C-反应蛋白检测的临床意义

目的探讨脂蛋白（a）与C-反应蛋白水平在急性脑梗死发病中的作用及临床意义。方法CRP水平由美国Beackman特定蛋白分析仪测定。脂蛋白（a）与血脂水平由美国Beackman全自动生化分析仪测定，同期测定30例健康体检者作为对照组并与之比较。结果脑梗死患者的血清脂蛋白（a）、C-反应蛋白水平显著高于对照组（P〈0．01），且脂蛋白（a）与CRP水平呈显著正相关（γ=0．710，P〈0．01）。结论①血清脂蛋白（a）是CRP水平升高的主要相关因素；②血清脂蛋白（a）和C反应蛋白含量的升高是脑梗死患者的危险因素。     

糖尿病合并冠心病老年患者氯吡格雷抵抗的危险因素分析

目的：分析2型糖尿病合并冠心病老年患者氯吡格雷抵抗发生情况及其危险因素。方法选择在重庆北部新区第一人民医院住院接受氯吡格雷治疗的2型糖尿病合并冠心病老年患者315例,服用氯吡格雷24 h后进行血小板聚集抑制率（△A ）检测,△A＞10％者为对照组（196例）,△A≤10％者为观察组（119例）。观察两组心血管病危险因素,糖、脂代谢及炎症指标水平差异。结果与对照组比较,观察组性别、年龄、吸烟史、高血压发病率、高脂血症发病率、体质量指数及三酰甘油、总胆固醇、低密度脂蛋白胆固醇、糖化血红蛋白水平等临床资料均差异无统计学意义（P＞0．05）;观察组超敏C反应蛋白以及空腹血糖、糖化血清蛋白水平明显增高,高密度脂蛋白胆固醇（HDL-C）水平明显偏低（P＜0．01）。结论糖尿病合并冠心病老年患者明显存在氯吡格雷抵抗现象,超敏C反应蛋白及空腹血糖、糖化血清蛋白水平增高而HDL-C水平降低,提示患者氯吡格雷抵抗风险可能增加。     

依达拉奉联合他汀类药物对缺血性脑卒中患者血清同型半胱氨酸、C反应蛋白、血脂水平的影响

目的观察缺血性脑卒中患者在给予依达拉奉联合他汀类药物治疗后血清同型半胱氨酸(Hcy)、C反应蛋白(CRP)、总胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白(HDL)和低密度脂蛋白胆固醇(LDL-C)水平变化。方法 63例脑卒中患者分为2组,对照组27例给予瑞舒伐他汀,观察组36例在对照组治疗基础上给予依达拉奉治疗。检测体内Hcy、TG、TC、HDL及LDL-C水平变化,同时在治疗前与治疗14 d后填写脑卒中量表NIHSS、日常生活能力Barthel指数自评表、焦虑自评表(SAS)及抑郁自评表(SDS)。结果观察组Hcy、CRP及LDL-C水平显著低于对照组,HDL显著高于对照组。观察组患者在治疗14 d后总有效率达88.89%,显著高于对照组的77.78%。观察组患者Barthel指数显著高于对照组,SAS、SDS指数均显著低于对照组(P0.05)。结论依达拉奉联合瑞舒伐他汀可显著提高缺血性脑卒中患者的治疗效果,优化患者预后及生活能力。     

Lipoproteins and acute phase response during acute infection. Interrelationships between C-reactive protein and serum amyloid-A protein and lipoproteins

To study the interrelations between the changes of acute phase proteins and those of serum lipoproteins in acute infections we measured the concentrations of different lipoproteins, serum amyloid-A protein and C-reactive protein and activities of lipoprotein lipase and hepatic lipase during acute and convalescence phase and after complete recovery in 64 patients with infectious diseases (30 with viral infection and 34 with bacterial infection). The maximal decrements of both low density lipoprotein and high density lipoprotein cholesterol correlated significantly with the acute phase levels of C-reactive protein and serum amyloid-A protein. The acute phase concentration of very low density lipoprotein triglyceride correlated inversely to C-reactive protein level (r = -0.31, P less than 0.05) but not to serum amyloid-A protein level. Regression analysis showed that the concentration of C-reactive protein was a significant predictor of very low density lipoprotein triglyceride level in the acute phase of infection but not during convalescence. These results and the previous findings that C-reactive protein binds to low and very low density lipoproteins and that serum amyloid-A protein is associated with high density lipoprotein give credence to the view that C-reactive protein and serum amyloid-A protein interfere with the metabolism of serum lipoproteins during acute phase of infection.     

The impact of hyperhomocysteinemia as a cardiovascular risk factor in the prediction of coronary heart disease.

Coronary heart disease often occurs in the absence of traditional risk factors. Consequently, epidemiological studies exploring novel risk factors are necessary to improve the prediction of coronary heart disease. This study evaluated five promising markers of cardiovascular risk: homocysteine, C-reactive protein, fibrinogen, lipoprotein(a) (Lp(a)), free apolipoprotein(a) (apo(a)) and Lp(a) phenotypes. The study included 135 patients with angiographically confirmed atherosclerosis. The control group consisted of 93 sex- and age-matched individuals. The Mann-Whitney U-test was used for group comparison. New risk factors were evaluated by binary logistic regression. The odds ratios were calculated continuously for homocysteine in dependence on C-reactive protein. Low density lipoprotein (LDL)-cholesterol was nearly identical in controls and patients. Homocysteine, C-reactive protein, fibrinogen, high density lipoprotein (HDL)-cholesterol and Lp(a) discriminated highly significantly between both groups. The continuously calculated odds ratio for homocysteine demonstrated a distinct influence of C-reactive protein. In the group with high C-reactive protein levels, homocysteine levels above 9.6 micromol/l resulted in a markedly elevated risk (odds ratio 12), in the group with C-reactive protein levels below 5 mg/dl, a comparable risk increase was observed at a homocysteine level of 16.6 micromol/l. This data strongly suggests that plasma homocysteine helps identify individuals at risk, especially among those with elevated C-reactive protein levels.     

2型糖尿病患者血清超敏C反应蛋白及血脂检测的临床意义

目的探讨血清超敏C反应蛋白(hs-CRP)和血脂在2型糖尿病患者诊断中临床意义。方法观察80例2型糖尿病患者(观察组)和50例健康体检者(对照组)血清hs-CRP、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平。分析观察组hs-CRP与血脂各项检测指标的相关性。结果与对照组比较,观察组血清TC、TG、LDL-C、hs-CRP水平明显高于对照组(P<0.01),HDL-C水平明显低于对照组(P<0.01)。观察组hs-CRP与TC、TG、LDL-C呈正相关(P<0.05或P<0.01),与HDL-C呈负相关(P<0.01)。结论血脂与炎症因子水平检测是糖尿病诊断的有效手段。     

Comparison of laboratory parameters as risk factors for the presence and the extent of coronary or carotid atherosclerosis: the significance of apolipoprotein B to apolipoprotein all ratio.

We compared several "new" risk factors (autoantibodies to oxidatively modified low density lipoprotein (LDL), sialic acid content of LDL, bilirubin and C-reactive protein) with "conventional" risk factors (apolipoprotein (apo) AI, AII and B, lipoprotein(a), triglycerides, and total, LDL and high density lipoprotein (HDL) cholesterol) for the presence and the extent of coronary or carotid atherosclerosis. Forty male patients with angiographically proven coronary atherosclerosis and 31 male patients with ultrasound-proven extracranial carotid atherosclerosis were compared to 40 age matched (53+/-5 years) healthy males as control subjects, with negative parental history of atherosclerosis, no clinical signs of systemic or organ-related ischemic disease and normal extracranial carotid arteries. The apo B/apo All ratio most powerfully indicated the presence and the extent of coronary or carotid atherosclerosis. Elevated lipoprotein(a) contributed significant additional information in the assessment of the atherosclerotic risk. Increase in C-reactive protein indicated the presence (but not the extent) of coronary or carotid atherosclerosis with a similar power as lipoprotein(a). Decreased values of total bilirubin indicated the presence of atherosclerosis only in smokers. Autoantibodies to oxidatively modified LDL additionally described the atherosclerotic process, but were less important than apolipoproteins, lipoprotein(a), C-reactive protein or bilirubin. Sialic acid content of LDL added no information to the parameters discussed above. We demonstrated that in male patients apolipoproteins, especially the apo B/apo All ratio, were better indicators of the presence and the extent of coronary or carotid atherosclerosis than C-reactive protein, bilirubin, autoantibodies to oxidatively modified LDL or sialic acid content of LDL.     

Serum Lp(a) concentrations are unaffected by treatment with the HMG-CoA reductase inhibitor Pravastatin: results of a 2-year investigation.

The concentration of lipoprotein (a) in plasma is under stringent genetic control and raised concentrations are strongly linked to coronary heart disease, in particular when low density lipoprotein levels are also increased. We serially monitored serum Lp(a) in 14 hypercholesterolemic patients who were treated with Pravastatin over a period of two years. C-reactive protein levels were also quantified to exclude a possible 'acute-phase' response as a reason for a sudden increase in the Lp(a) concentration. No significant changes were seen in mean Lp(a) levels after 24 months of therapy. Considerable fluctuations of serum Lp(a) levels occurred during the course of treatment. These were in some cases associated with raised C-reactive protein concentrations and might therefore be attributable to an 'acute-phase' response. We conclude that the HMG-CoA reductase inhibitor Pravastatin has no long-lasting effects on Lp(a) levels in hypercholesterolemic patients suffering from coronary heart disease.