大剂量血脂康在经皮冠状动脉介入术中的炎症抑制作用

目的： 研究不稳定型心绞痛(UA)患者在经皮冠状动脉介入(PCI)治疗前应用大剂量血脂康对炎症的抑制作用。 方法： 对196例临床确诊为高危UA（心绞痛Braunwald 分级为Ⅲ和ⅡB级,CRP＞3 mg/L）的患者按随机原则分别入选A组和B组,在相似常规治疗的基础上分别口服1.2 g/d和2.4 g/d血脂康治疗72 h。随后对所有病人进行冠状动脉造影和PCI治疗。测定在入院时、药物治疗3 d后（PCI术前）和PCI术后48 h的血浆CRP的水平，并随访半年内的冠脉事件和左室射血分数。 结果： 入院时2组血浆CRP水平无明显差别（P＞0.05）；治疗3 d后，两组血浆CRP水平明显低于入院时［A组：（5.44±1.57）mg/L vs （4.04±1.54） mg/L；B组： （5.42±1.36） mg/L vs （3.60±1.14） mg/L,P＜0.05］；PCI术后48 h，两组血浆CRP水平显著高于术前［A组升至 （9.22±5.03） mg/L；B组升至（4.97±1.75） mg/L，P＜0.05］。PCI术前及术后48 h，B组的血浆CRP水平明显低于同期A组(P＜0.05)。术后半年主要冠脉事件B组明显少于A组［21/104 (20.2%) vs 9/92 (9.8%)，P＜0.05］，左室射血分数B组明显高于A组(55.41％±10.93% vs 59.30％±9.99%,P＜0.05)。 结论： PCI术前大剂量血脂康治疗对PCI术引起的炎症具有抑制作用，抑制炎症可能是PCI术后冠脉事件减少和左室射血分数增加的重要因素。

Inhibitory effect of high-dose Xuezhikang on inflammatory response induced by percutaneous coronary intervention in patients with unstable angina

AIM: To study the inhibitory effect of high-dose Xuezhikang,administered before percutaneous coronary intervention (PCI) on inflammatory response induced by PCI in patients with unstable angina (UA).METHODS: All patients with UA in class Ⅲ and ⅡB according to Braunwald classification were considered for inclusion in the present study.Finally,196 patients received Xuezhikang treatment 72 h before coronary angiography and successfully performed PCI with elevated C-reactive protein (CRP) level (>3 mg/L) were randomised to 2 groups: 1.2 g/d of Xuezhikang as group A,or 2.4 g/d of Xuezhikang as group B.The levels of CRP were measured at baseline,after 3 days of therapy (before procedure) and 48 hours after PCI.The patients were followed-up for 6 months for major adverse coronary events and left ventricular ejection fraction.RESULTS: There was no significant difference in the mean CRP level among the two randomized groups (P>0.05),however,after three days of pharmacological treatment,there was significantly reduced CRP content in group A ［(5.44±1.57） mg/L vs （4.04±1.54） mg/L,P<0.05］ and in group B ［(5.42±1.36） mg/L vs （3.60±1.14） mg/L,P<0.05］ compared with admission.Measurements performed 48 hours after the procedure revealed a marked CRP level increase in group A (up to 9.22 mg/L±5.03 mg/L) and an obvious increase in groups B (up to 4.97 mg/L±1.75 mg/L,P<0.05) compared with pre-procedure.The serum level of CRP in B group was distinctly lower than that in A group before (P<0.05) and after the procedure (P<0.05),respectively.Major adverse coronary events during the 6-month clinical follow-up occurred less in group A than that in group B ［21/104 (20.2%) vs 9/92 (9.8%); patients,P<0.05］.Follow-up echocardiography revealed lower left ventricular ejection fraction in group A than that in group B (55.41%±10.93% vs 59.30%±9.99%,P<0.05).CONCLUSION: High-dose Xuezhikang therapy,administered before PCI,has better inhibition effect than low-dose on inflammatory response induced by PCI in patients with UA.Attenuation of inflammatory response may be crucial for the reduction of coronary events following invasive coronary interventions.