阿托伐他汀对急性冠状动脉综合征病人炎症因子影响

【摘要】  　　目的 探讨阿托伐他汀对急性冠状动脉综合征病人血清白细胞介素?18（IL?18）、高敏C?反应蛋白(hs?CRP)的影响。方法 选取在我院心内科住院的不稳定型心绞痛病人30例，稳定型心绞痛病人20例，以20例健康人作为正常对照组，分别测定其血脂、IL?18和hs?CRP水平。不稳定型心绞痛组入院后每晚给予阿托伐他汀20 mg，每日1次，共用药6周，测定治疗后病人血脂、IL?18和hs?CRP水平。结果 正常对照组、稳定型心绞痛组和不稳定型心绞痛组的血清IL?18和hs?CRP水平差别有统计学意义（F=190.961、22.359,P<0.01)，不稳定型心绞痛组高于稳定型心绞痛组和对照组,稳定型心绞痛组高于对照组。不稳定型心绞痛组治疗后IL?18和hs?CRP水平均明显下降，差异有统计学意义（t=12.553、7.991,P<0.01）。结论 IL?18和hs?CRP是反映冠状动脉粥样硬化病变炎症反应的重要指标；阿托伐他汀能降低急性冠状动脉综合征病人的炎症反应。 
【关键词】  冠状动脉综合征 白细胞介素?18 C反应蛋白质 阿托伐他汀
　　［ABSTRACT］ Objective To study the effect of atorvastatin on plasma interleukin?18 (IL?18) and high sensitivity C?creactive protein(hs?CRP) levels in patients with acute coronary syndrome (ACS). Methods Patients with unstable angina (30 cases) and stable angina (20 cases) hospitalized in Department of Cardiology of our hospital were included in this study,  20 normal people served as controls. Those with unstable angina were given atorvastatin (20 mg per night) for six weeks. Levels of IL?18, and hs?CRP were measured. Results The serum levels of IL?18 and hs?CRP were significantly different among the three groups (F=190.961,22.359;P<0.01). Those in the unstable angina group were significantly higher than that of the stable angina group, the latter was higher than those of the normal group. After atorvastatin treatment, the serum levels of IL?18 and hs?CRP in the unstable angina group were significantly lower than before the treatment (t=12.553, 7.991;P<0.01). Conclusion The results suggest that  IL?18 and CRP are major indictors of inflammation in coronary atherosclerotic lesions and atorvastatin could significantly decrease the local inflammation of acute coronary syndrome.
    
　　［KEY WORDS］ Coronary syndrome; Interleukinn?18; C?reactive protein; Atorvastatin
    
　　研究显示，冠状动脉病变不仅仅是一种动脉壁内脂质堆积性疾病，炎症及免疫过程也参与了动脉粥样硬化的发生发展[1]。白细胞介素?18（IL?18）作为重要的前炎症因子，在冠状动脉粥样硬化性心脏病的发生发展及粥样斑块破裂的过程中起重要作用[2]。急性冠状动脉综合征是由于冠状动脉内粥样斑块破裂，表面破损或出现裂纹，继而出血和血栓形成，引起冠状动脉不完全或完全阻塞所致。因此，稳定斑块、防止冠状动脉危险事件的发生就显得尤为重要。他汀类药物作为冠心病的常规用药, 除了具有调脂作用之外，还具有抗炎、稳定斑块、改善血管内皮、抑制血管平滑肌的增殖、抑制血栓形成等非调脂作用，近年来其非调脂作用已越来越引起人们的重视[3]。大量的临床研究结果表明，应用他汀类药物能降低急性冠状动脉综合征病人的炎症反应，稳定斑块，减少冠状动脉危险事件的发生。本研究通过观察阿托伐他汀对不稳定型心绞痛病人血清IL?18和高敏C?反应蛋白(hs?CRP)的影响，进一步探讨其临床应用价值。
　　1  资料和方法

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