【作者】 李莹；

【导师】 余国龙；

【作者基本信息】 中南大学 ， 内科学， 2009， 硕士

【摘要】 目的：探讨阿托伐他汀强化治疗短期(5天)内对急性冠脉综合征(ACS)患者血浆B型钠尿肽(B-type natriuretic peptide或称脑钠肽brain natriuretic peptide,BNP)及血脂水平的影响。对象和方法：本研究为随机单盲、对照研究。选取46例ACS患者,于入院24小时内均予以常规治疗(包括溶栓剂、抗凝剂、ACEI、p受体阻滞剂、钙通道拮抗剂、硝酸酯类等)并随机分为两组：常规治疗组(阿托伐他汀20mg,一次／晚)、强化治疗组(阿托伐他汀40mg,一次／晚),分别治疗前及治疗5天后检测患者血浆BNP、血脂水平。另选取正常体检者23例为对照组。结果：1)、常规治疗组与强化治疗组ACS患者入院治疗前的血脂TC、TG、HDL及LDL-C水平无差别(P>0.05),具有可比性。治疗5天后两组患者TC、TG、HDL及LDL-C无明显改变(P>0.05)。2)、常规治疗组与强化治疗组患者治疗前血浆BNP水平无明显差别(P>0.05),但均较对照组明显增高(P=0.000)。治疗5天后,常规治疗组血浆BNP由683.23±199.56pg／ml降至574.56±194.08pg／ml(P=0.001),强化治疗组由674.24±173.55 pg／ml降至420.31±141.93 pg／ml(P=0.000)。3)、强化治疗组BNP下降水平与常规治疗组更为显著,两组比较有统计学意义(P<0.01)。结论：1、ACS患者BNP水平显著高于对照组人群,表明ACS急性发病期存在心功能障碍。2、阿托伐他汀强化及常规短期治疗对ACS患者均能降低血浆BNP水平,而对其血脂水平前后无显著性影响。说明其降脂作用在短期内尚未显现,且其改善心功能标志物血浆BNP作用独立于降脂作用。3、大剂量阿托伐他汀强化治疗组的血浆BNP下降水平较常规剂量组更为显著,表明其降低BNP的作用可能与剂量有关。4、对ACS患者阿托伐他汀强化治疗与常规治疗短期治疗安全性相似。更多还原

【Abstract】 Objectives:To observe the early effects(5 days) on BNP(B-type natriuretic peptide/brain natriuretic peptide) and serum lipids by atorvastatin intensive treatment in patients with acute coronary syndrome(ACS).Subjects & Methods:Forty-six patients with ACS admitted in the Dept. Cardiology, Xiangya hospital from Sept.2008 to Feb.2009, diagnosed by clinical symptoms, electrocardiogram, myocardial enzymes, troponin I, coronary angiography & other inspections, were enrolled in this study. All patients were given conventional treatments (including thrombolytic agents, anticoagulant, ACEI,calcium channel antagonists and nitrate, etc) within 24 hours after being hospitalized, and then divided randomly into two groups:conventional therapy group (atorvastatin 20mg QN) and the enhanced treatment group (atorvastatin 40mg QN). Before and after five days treatment, the levels of plasma BNP and lipids were detected. In addition,23 patients acted as control group, whose relevant examination results including blood biochemistry, myocardial enzymes, ECG, echocardiography and coronarography were normal.Results:1). The levels of plasma TC, TG, LDL, HDL showed no significant difference between the conventional therapy group and the enhanced treatment group before treatment (P>0.05).At five days after treatment, the TC, TG, LDL were decreased and the HDL increased in the both groups. But the difference between before and after treatment in the both groups had no statistical significance (P>0.05)2). There was no difference in plasma BNP level between the conventional therapy group and the enhanced treatment group before the treatment (P>0.05), but dramatically much higher than control group (P=0.000). After 5 days’treatment, the BNP levels was decreased from 683.23±199.56 pg/ml to 574.56±194.08 pg/ml (p=0.001) in the conventional therapy group, and from 674.24±173.55 pg/ml to 420.31±141.93 pg/ml (P=0.000) in the enhanced treatment group.3). The plasma BNP level in the enhanced treatment group was decreased significantly compared with that in the conventional therapy group (P<0.01).Conclusions:1). The plasma BNP level in the patients with ACS was much higher than healthy persons, which suggested that the patients with ACS were associated with heart dysfunction.2). The atorvastatin enhanced and regular treatment for five days could obviously reduce the level of plasma BNP, while the plasma levels of TC, TG, HDL and LDL-C were changed without significance. The findings indicated the heart function improvement by atorvastatin was independent on lowering lipids.3). The decline of the level of plasma BNP in the atorvastatin enhanced treatment group was more obvious than that in the regular treatment group, which suggested the efficiency was possibly dose dependent.4). The safety was similar between enhanced treatment group and regular conventional therapy group for short period in patients with ACS.更多还原