【摘要】 探讨炎症在急性冠状动脉综合征发病中的作用 ,以及他汀类药物治疗急性冠状动脉综合征的机制。分别测定 5 0例急性冠状动脉综合征患者 (急性心肌梗死 2 0例 ,不稳定型心绞痛 30例 )、34例稳定型心绞痛患者及 30例正常对照者的血清白细胞介素 6和高敏C反应蛋白水平 ;并从急性冠状动脉综合征组随机抽取 30例患者随机分成辛伐他汀组和常规组 ,每组 15例 ,干预 3周 ,分析比较组间及辛伐他汀治疗前后血清白细胞介素 6、高敏C反应蛋白及血脂水平变化 ,以及血清白细胞介素 6、高敏C反应蛋白水平与冠心病的相关性。结果发现 ,急性冠状动脉综合征组血清白细胞介素 6和高敏C反应蛋白水平均明显高于稳定型心绞痛组及正常对照组 (P <0 .0 0 1)。治疗3周后 ,辛伐他汀组血清白细胞介素 6、高敏C反应蛋白、总胆固醇和低密度脂蛋白胆固醇浓度明显下降 (P <0 .0 0 1) ;辛伐他汀组和常规组组间白细胞介素 6和高敏C反应蛋白水平下降率相比有统计学差异 (P <0 .0 5 )。相关分析显示 ,辛伐他汀组血清白细胞介素 6、高敏C反应蛋白下降与血脂下降无关。单因素回归分析及调整传统冠心病危险因素后的多因素回归分析均显示 ,血清高敏C反应蛋白水平与冠心病显著相关 (P <0 .0 5 )。结果提示 ,炎症在急性冠状动脉综合征的发生中起了重更多还原

【Abstract】 Aim To explore the role of inflammation in acute coronary syndrome (ACS) and the mechanism by which statin treat ACS. Methods The serum high-sensitivity C-reactive protein (hs-CRP) and interleukin-6 (IL-6) levels were measured in 50 patients with ACS, including 30 patients with unstable angina (UA) and 20 patients with acute myocardial infarction (AMI), 34 patients with stable angina (SA) and 30 controls. 30 patients in ACS group were randomly selected and assigned to the simvastatin group (n=15) and the routine group (n=15). The simvastatin group was given simvastatin 20 mg/d and the routine group took placebo expect routine treatment (including nitrate, aspirin , β-blocker and ACEI ). After a three-week follow-up, serum hs-CRP, IL-6 levels and serum lipids concentrations were measured again. Results Both serum IL-6 and hs-CRP levels were significantly higher in ACS group than in SA and normal control group(P<0.001). After three-week treatment with simvastatin, serum IL-6, hs-CRP, total cholesterol (TC) and low density lipoprotein cholesterol (LDLC) levels decreased significantly in the simvastatin group (P<0.001), but not in the routine group. The rates of decrease of IL-6 and hs-CRP was significantly different between simvastatin group and routine group (P<0.05). No relationship was observed between the values of decrease of serum IL-6 or hs-CRP and serum lipids levels. The serum hs-CRP level showed significant correlation with coronary heart disease (CHD) in both univariate regression pattern and multivariate regression pattern (P<0.05) . Conclusions Inflammation plays an important role in the initiation of ACS. Assaying serum IL-6 and hs-CRP levels may be able to help to definite the diagnosis of ACS. Simvastatin possess anti-inflammatory effect which independent of its lipid lowering action, and the anti-inflammatory effect of simvastatin might play an important role in the early treatment of ACS.更多还原