他汀类药物对冠脉综合征患者血清hs-CRP与颈动脉IMT的影响

目的：探讨他汀类药物对冠脉综合征患者血清超敏C反应蛋白(hs-CRP)和颈动脉内膜中层厚度（IMT）的影响。方法选取2012年6月至2015年1月期间我院心血管内科确诊治疗的冠脉综合征患者150例，依据随机分配原则分为常规组和他汀组，每组75例，常规组患者给予抗血小板、抗凝、溶栓、抗缺血、抗心力衰竭及心律失常等常规治疗和10 mg阿托伐他汀口服治疗，他汀组患者在基础治疗上给予20 mg阿托伐他汀口服治疗，两组均持续治疗1个月，采用酶联免疫吸附法(ELISA)检测血清hs-CRP水平，随访1年，统计分析所有患者治疗前后颈动脉IMT、斑块大小、厚度、数量和治疗前、治疗后3个月、6个月、12个月的血清hs-CRP水平及左心射血分数(LVEF)、不良心脏事件发生情况。结果治疗前，常规组和他汀组患者颈动脉IMT (1.74±0.46) mm vs (1.71±0.44 mm]、斑块大小(23.58±5.84) mm2 vs (24.02±5.91) mm2]、厚度(2.82±0.82) mm vs (2.76±0.79) mm]、数量(5.48±0.64)个vs (5.39±0.61)个]和血清hs-CRP (27.46±7.31) mg/L vs (28.06±7.41) mg/L]水平基本相同，差异均无统计学意义(P>0.05)；治疗后，他汀组患者颈动脉IMT (1.21±0.34) mm vs (1.52±0.38) mm]、斑块大小(14.57±4.72) mm2 vs (19.51±5.41) mm2]、厚度(1.53±0.52) mm vs (1.89±0.61) mm]、数量(2.94±0.33)个vs (3.52±0.38)个]和3个月(18.32±7.02) mg/L vs (24.23±7.11) mg/L]、6个月(12.36±6.13) mg/L vs (18.43±7.05) mg/L]、12个月(7.63±3.21) mg/L vs (11.36±5.03) mg/L]的血清hs-CRP水平明显低于常规组，差异均有统计学意义(P<0.05)；他汀组患者治疗后LVEF水平为(57.96±8.11%)%，明显高于常规组的(52.13±7.84)%，不良心脏事件发生率为4.00%，明显低于常规组的13.33%，差异有统计学意义(P<0.05)。结论较大剂量他汀类药物可有效缓解冠脉综合征患者的颈部血管斑块及机体炎症状态，改善患者左心室功能，且可有效减少不良心脏事件的发生，值得临床推广应用。

Effect of statins on serum hypersensitive C-reactive protein and carotid intima-media thickness in patients with coronary artery disease

Objective To discuss the effect of statins on serum hypersensitive C-reactive protein (hs-CRP) and carotid intima-media thickness (IMT) in patients with coronary artery disease. Methods A total of 150 patients with coro-nary syndrome, who admitted to Department of Cardiovasology of the People's Hospital of Yongchuan District of Chongq-ing from June 2012 to January 2015, were selected and divided into the conventional group and the statin group according to the random distribution, with 75 cases in each group. The conventional group patients were given antiplatelet, anticoagu-lation, thrombolysis, anti-ischemic, anti-heart failure, arrhythmia and other conventional treatment as well as 10 mg oral atorvastatin treatment;the statin group patients were treated with additionally 20 mg oral atorvastatin treatment based on the treatment of the conventional group. The two groups were treated for 1 month, and the serum hs-CRP levels were de-tected by enzyme-linked immunosorbent (ELISA) method. Followed up for 1 year, the carotid artery IMT, size, thickness and number of plaque before and after treatment, the levels of serum hs-CRP, left ventricular ejection fraction (LVEF), and adverse cardiac events before and after treatment at 3 months, 6 months and 12 months were analyzed. Results Before the treatment, the carotid artery IMT, size, thickness and number of plaque, the levels of serum hs-CRP were (1.74±0.46) mm, (23.58 ± 5.84) mm2, (2.82 ± 0.82) mm, (5.48 ± 0.64), (27.46 ± 7.31) mg/L in the conventional group and (1.71 ± 0.44) mm, (24.02±5.91) mm2, (2.76±0.79) mm, (5.39±0.61) and (28.06±7.41) mg/L in the statin group, respectively, and there was no significant difference between the two groups (P>0.05). After the treatment, the carotid artery IMT, size, thickness and num-ber of plaque, the levels of serum hs-CRP of 3 months, 6 months and 12 months in the statin group were (1.21±0.34) mm, (14.57 ± 4.72) mm2, (1.53 ± 0.52) mm, (2.94 ± 0.33), (18.32 ± 7.02) mg/L, (12.36 ± 6.13) mg/L and (7.63 ± 3.21) mg/L, which were significantly lower than (1.52 ± 0.38) mm, (19.51 ± 5.41) mm2, (1.89 ± 0.61) mm, (3.52 ± 0.38), (24.23 ± 7.11) mg/L, (18.43 ± 7.05) mg/L, (11.36 ± 5.03) mg/L in the conventional group (P<0.05). The LVEF level after the treatment in the statin group was (57.96 ± 8.11)%, which was significantly higher than (52.13 ± 7.84)%in the conventional group;the inci-dence of adverse cardiac events in the statin group was 4.00%, which was significantly lower than 13.33%in the conven-tional group. All of the above differences were statistically significant (P<0.05). Conclusion Statins can effectively alle-viate the carotid plaque and inflammatory state in patients with coronary artery disease, and improve left ventricular func-tion. It can also effectively reduce the occurrence of adverse cardiac events, so it's worth for further clinical promotion.