【作者】 孙彦彦；

【导师】 邱春光；

【作者基本信息】 郑州大学 ， 内科学， 2010， 硕士

【摘要】 研究背景研究显示,冠状动脉粥样硬化性疾病是一种慢性炎症性疾病,炎症因子在动脉粥样硬化发生发展过程中起着重要的作用,而抗炎治疗也成为动脉硬化防治的新领域。脂蛋白相关磷脂酶A2(Lp-PLA2)是一种炎症因子,研究表明,在动脉粥样硬化斑块中Lp-PLA2升高,且与斑块的不稳定性相关,是冠心病的独立危险因素。他汀类药物具有抗炎等降脂外的作用,对稳定斑块,改善冠心病的预后起着重要的作用。目的探讨脂蛋白相关磷脂酶A2与冠状动脉粥样硬化病变程度及斑块稳定性的关系；应用不同剂量的阿托伐他汀对冠心病患者血清Lp-PLA2的影响。方法对86例可疑冠心病患者行冠脉造影,根据冠脉造影结果分为对照组(24例)和冠心病组(62例),冠心病组随机分为2组,分别给予阿托伐他汀20mg及80mg。根据临床类型分为急性冠脉综合征组(42例)和稳定型心绞痛组(20例)。以病变支数和Gensini积分评价动脉粥样硬化病变程度,以临床分型评价斑块稳定性。检查所有患者入院时血清Lp-PLA2水平、hs-CRP等指标,分析Lp-PLA2、hs-CRP等与冠状动脉病变支数、Gensini积分、斑块稳定性的关系。1周后再次抽血测定其Lp-PLA2值、hs-CRP等,比较口服不同剂量阿托伐他汀对Lp-PLA2值、hs-CRP的影响。结果冠心病组Lp-PLA2活性显著高于对照组(P<0.05),而且随着冠脉病变支数的增加和Gensini积分的增加而逐渐升高。在急性冠脉综合征组较稳定型心绞痛组升高。Lp-PLA2活性与hs-CRP无明显相关性。口服阿托伐他汀1周后Lp-PLA2值、hs-CRP均下降,大剂量80mg组较常规剂量20mg组血清Lp-PLA2、hs-CRP水平下降更明显。结论冠心病患者血清Lp-PLA2水平与冠状动脉粥样硬化病变程度及斑块稳定性有关。口服大剂量阿托伐他汀1周后较常规剂量组更能降低血清Lp-PLA2、hs-CRP水平。更多还原

【Abstract】 BackgroundIt is indicated that coronary atherosclerosis disease (CHD) is a disease of chronic inflammation, inflammation plays an important role in the development and progress of atherosclerosis, and anti-inflammatory therapy comes a frontier of atherosclerosis prevention. Lipoprotein-associated pospholipase A2 (Lp-PLA2) is a inflammation factor, lots of studies showed that Lp-PLA2 increased in the atherosclerotic plaque, and is correlated to the stability. It is a independent risk factor of CHD. Statins has anti-inflammatory effect except for reduce blood fat. It also can stable plaque and improve prognosis of CHD.ObjectiveTo investigate the correlations between serum levels of lipoprotein-associated pospholipase A2 and the severity and stability of coronary atherosclerosis. To observe the influence of different dosage of atorvastatin play on plasma Lp-PLA2 of coronary artery disease patients.MethodsCoronary angiography (CAG) was performed in 86 patients who were suspected as having coronary artery disease(CHD). According to the coronary artery chanrges and plaque characters in CAG, all patients were divided into control group(n=24) and CHD group(n=62). According to the clinical types, the CHD patients were divided into acute coronary syndrome (ACS) group (n=42) and stable angina pectoris (SAP) group (n=20). According to the dose of atorvastatin, CHD group was divide into two groups in random, and was given 20mg and 80mg atorvastatin every night. The number of diseased coronary branches and Gensini’s score is use for evaluate the severity of atherosclerosis. The clinical types is use for evaluate the stability of plaque. Lp-PLA2 and hs-CRP were measured in all the patients. The correlation between serum Lp-PLA2 with hs-CRP and the number of diseased coronary branches, Gensini’s score, clinical types were analyzed. The CHD group were withdrawal one week later, determine the serum Lp-PLA2 level and hs-CRP. Compare the influence of different dosage of atorvastain.ResultsLp-PLA2 in CHD patients was significantly higher than that in control group(P<0.05) and increased with the increasing number of diseased coronary branches and Gensini’s score. Lp-PLA2 in ACS group was higher than SAP group. Lp-PLA2 level had no correlated with hs-CRP. Lp-PLA2 level was lower in the patients were given 80mg atorvastatin than 20mg.ConclusionCHD patients serum Lp-PLA2 level is correlated with the severity of atherosclerosis and the stability of plaque. Take atorvastatins 80mg/d for one week could depress Lp-PLA2 and hs-CRP more than routine dose.更多还原