【摘要】 目的观察在合并高脂蛋白a血症的急性冠脉综合征(acute coronary syndrome,ACS)患者中瑞舒伐他汀钙联合烟酸治疗对其内皮功能的影响。方法入选合并高脂蛋白a血症的ACS患者共60例,分为瑞舒伐他汀钙治疗组及瑞舒伐他汀加烟酸缓释片联合治疗组,同期非冠状动脉粥样硬化性心脏病(冠心病)患者作为对照组。观察治疗前、治疗后4周及6个月血脂、脂联素(adiponectin,APN)、内皮祖细胞(endothelial progenitor cells,EPCs)及血流介导的内皮依赖性舒张功能(flow-mediated endothelium-dependent relaxation function,FMD)的变化。结果他汀组和联合治疗组各临床指标比较,差异无统计学意义(P>0.05)。APN及EPCs在对照组均显著高于ACS患者,差异有统计学意义(P<0.01)。他汀组治疗4周后血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)浓度均有明显下降,差异有统计学意义(P<0.05);高密度脂蛋白胆固醇(HDL-C)浓度治疗6个月后有显著提高,差异有统计学意义(P<0.05);三酰甘油(TG)、脂蛋白a[LP(a)]浓度在6个月的治疗中未见明显改变。联合治疗组血清三酰甘油、脂蛋白a浓度6个月后有显著下降,差异有统计学意义;其FMD在治疗4周时较他汀组有显著提高,差异有统计学意义(P<0.05);6个月后升高更明显,差异有统计学意义(P<0.01)。他汀组治疗6个月后APN及EPCs有显著升高,联合治疗组治疗6个月后APN及EPCs均较他汀组显著升高,差异有统计学意义(P<0.05)。两组患者均未见与用药有关的严重不良反应发生,联合治疗组有10例在用药早期出现面色潮红,伴有皮肤瘙痒,4周后症状消失。结论对低高密度脂蛋白胆固醇浓度及高脂蛋白a的高危ACS患者,联用他汀类药物及烟酸缓释制剂是合理的。更多还原

【Abstract】 Objectives To observe the endothelial function changes in patients with hyperlipoproteinemia and acute coronary syndrome treated by rosuvastatin calcium combined with nicotinic acid. Methods Totally 60 patients with hyperlipoproteinemia and acute coronary syndrome were enrolled. They were divided into rosuvastatin calcium group and rosuvastatin calcium plus nicotinic acid group. Meanwhile,patients without coronary heart disease were set to control group. Blood lipids, adiponectin(APN),endothelial progenitor cells(EPCs) and flow-mediated endothelium-dependent relaxation function(FMD) were recorded before and 4 weeks, 6 months after treatment respectively. Results Clinical indicators in statin and combination therapy groups were not significantly different(P>0.05). APN and EPCs in patients without coronary heart disease were significantly higher than those in patients with ACS(P<0.01). In statin group, serum concentrations of total cholesterol(TC) and low-density lipoprotein cholesterol(LDL-C) significantly decreased after 4weeks’ treatment(P<0.05), and serum concentration of high-density lipoprotein cholesterol(HDL-C) significantly improved 6 months after treatment(P <0.05), but serum concentrations of triglycerides(TG) and lipoprotein a [LP(a) ] did not change obviously after 6 months ’ treatment. In combination therapy group, serum concentrations of TG and LP(a) significantly decreased in 6 months, FMD significantly increased compared with that in statin group in 4weeks(P<0.05) and increased more obviously in 6 months(P<0.01). APN and EPCs of patients in statin group significantly increased in 6 months, and they were even higher in combination therapy group in 6 months(P<0.05). There were no serious drug-related adverse events in both groups. Flushing and itching occurred in 10 patients of combination therapy group at the early stage, but the symptoms disappeared in 4 weeks. Conclusions It is reasonable to use statins combined with nicotinic acid in high-risk ACS patients with low HDL-C and high LP(a).更多还原