【作者】 杨长宝；

【导师】 李莉；

【作者基本信息】 郑州大学 ， 急诊医学， 2010， 硕士

【摘要】 目的：目前尽管进行了再灌注和优化的药物治疗,但仍有相当一部分急性冠脉综合征(acute coronary syndrome, ACS)患者显示出异常的心肌灌注,导致梗死面积扩大、左室射血分数降低和存活率减少。内皮细胞激活和炎症因子的释放在ACS发生发展过程中扮演着重要的角色。血管性血友病因子(von Willebrand factor, VWF)是反映急性内皮损伤极为特异性的炎症因子,大量的研究表明,血浆VWF水平增高是ACS患者预后不良的独立危险因素。他汀类药物是冠心病治疗的基础药物,除了降脂外,还有稳定斑块、改善内皮功能、抗炎、抗氧化等重要作用。本研究旨在：1,观察VWF在健康人群、稳定型心绞痛和ACS患者中不同的表达程度以评价VWF与ACS的相关性；2,观察不同剂量瑞舒伐他汀对VWF的抑制作用,以寻求一种新的、具有潜在价值的治疗ACS的思路。方法：共入选110例研究对象：20例健康正常人(对照组),30例稳定型心绞痛患者(SA组)、30例ACS患者(ACS组)、30例使用高剂量瑞舒伐他汀ACS患者(H组)；ACS组和H组分别于入院时和一周后共抽血两次,对照组和SA组于入院时抽血一次；应用酶联免疫吸附法(enzyme-like immunosorbent assay, ELISA)测定血浆VWF水平。结果：1.稳定型心绞痛组与对照组之间血浆VWF水平无显著差异(P>0.05)；ACS组和H组之间血浆VWF水平无显著差异(P>0.05)；ACS组和H组较稳定型心绞痛组和对照组血浆VWF水平显著升高(P<0.05)；2.ACS组一周后血浆VWF水平与入院时相比无显著变化(P>0.05)；H组一周后血浆VWF水平较入院时显著降低(P<0.05)。结论：1.在一般人群中,血浆VWF水平只是一个很弱的冠心病预测指标；2.血浆VWF水平升高是ACS发生的标志物,VWF在ACS的进程中可能扮演着重要的角色；3.使用高剂量瑞舒伐他汀可以降低ACS患者的血浆VWF水平,具有内皮保护作用,而且其作用独立于降脂作用之外。更多还原

【Abstract】 The Clinical Research of The Correlation between VWF and ACS and The Therapeutical Effect of Different doses of RosuvastatinObjective:Despite of receiving reperfusion therapy and optimal medication, abnormal myocardial perfusion can be seen in patients with acute coronary syndrome (ACS) which expands the infarction area, decreases the left ventricular ejection fraction, and reduces the livability. The activation of endothelial cell and the releasing of inflammation factors play an important role in the occurrence and process of ACS. Von Willebrand factor (VWF) is a very specific inflammation factor reflecting acute endothelial injuries. A number of studies showed that increased concentration of plasma VWF was an independent risk factor of unfavorable prognosis in patients with ACS. Statins is the base drug in the treatment of coronary heart disease. Besides of lowering cholesterol, statins stabilize plaque, improve endothelial function, anti-inflammation, anti-oxidant etc. This study aims to:1.observe various plasma concentration of VWF in health adult, patients with stable angina and ACS to evaluate the correlation between VWF and ACS; 2.observe the inhibition of VWF by different doses of Rosuvastatin to seek a new and potential valued treatment of ACS.Methods:Selected 110 subjects. They were divided into four groups:20 healthy adults (control group); 30 patients with stable angina (SA group); 30 patients presenting with ACS (ACS group); 30 patients with ACS treated by high-dose Rosuvastatin (H group). Patients in ACS group and H group had plasma samples taken at admission and one week later. The control group and UA group had plasma samples taken at admission. Plasma concentration of von Willebrand factor was measured by enzyme-like immunosorbent assay (ELISA). Results:1. There was no significant difference of the VWF plasma concentration between SA group and the control group (P>0.05)、the ACS group and the H group (P>0.05); VWF plasma concentration is significantly higher of the patients in the ACS group and the H group than that of the patients in the SA group and the control group (P<0.05).3. There is no significant change of VWF plasma concentration one week later in ACS group (P<0.05). But significant depression of the VWF plasma concentration was observed in the H group one week later (P<0.05).Conclusions:1. Plasma VWF concentration is a weak predictor of coronary heart disease in the general population;2. The increased VWF plasma concentration is a marker of the occurrence of ACS; it may play an important role in the process of ACS;3. High dose of Rosuvastatin can decrease VWF plasma concentration in patients with ACS, has endothelial protective effect. And this is independent of its lipid-lowering effects.更多还原