阿托伐他汀、氟伐他汀对不稳定型心绞痛患者介入术后基质金属蛋白酶9、白细胞介素18的影响

李勇.阿托伐他汀、氟伐他汀对不稳定型心绞痛患者介入术后基质金属蛋白酶9、白细胞介素18的影响[J].中国医师进修杂志,2013,36(10):19-22.

心绞痛 不稳定型 基质金属蛋白酶9 白细胞介素18 阿托伐他汀 氟伐他汀

李勇

山东省乐陵市人民医院心内科

2013

19-22.

万方

目的 探讨阿托伐他汀、氟伐他汀对不稳定型心绞痛患者介入术后基质金属蛋白酶9(MMP-9)、白细胞介素18(IL-18)的影响.方法 选取104例不稳定型心绞痛患者,按随机数字表法分为阿托伐他汀组与氟伐他汀组,每组52例,在常规治疗基础上阿托伐他汀组给予阿托伐他汀10 mg/d,氟伐他汀组给予氟伐他汀40 mg/d治疗,疗程6周,观察两组血脂、MMP-9、IL-18变化.结果 阿托伐他汀组与氟伐他汀组入院时、术前1d、术后1d、术后6周MMP-9、IL-18水平比较差异无统计学意义(P＞0.05),术后1 d MMP-9、IL-18水平明显升高,与入院时、术前1d比较差异有统计学意义[(328.47±49.15)μg/L比(237.10±57.32)、(235.97±56.24) μg/L,(218.75±38.00) ng/L比(120.42±25.50)、(115.22 ±28.93) ng/L和(330.42±50.04) μg/L比(235.98±60.36)、(236.29±53.02)μg/L,(220.16±37.12) ng/L比(119.43±24.85)、(117.14±26.80) ng/L](P＜ 0.05),术后6周MMP-9、IL-18水平明显下降[(152.28±43.20) μg/L、(101.36±23.67) ng/L和(150.30±44.18) μg/L、(100.45±24.58) ng/L],与人院时、术前1d、术后1d比较差异均有统计学意义(P＜0.05).阿托伐他汀组与氟伐他汀组入院时、术前1d、术后1d三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平比较差异无统计学意义(P＞0.05),两组术后6周TG、TC、HDL-C、LDL-C水平比较差异有统计学意义[(2.05±1.00)、(5.15±0.61)、(1.84±0.50)、(3.13±0.88) mmol/L和(1.87±1.05)、(5.52±0.84)、(2.82±0.57)、(2.61±0.79) mmol/L](P＜ 0.05),术后ldTG、TC、HDL-C、LDL-C水平与入院时、术前ld比较差异无统计学意义(P＞0.05),术后6周TG、TC、HDL-C、LDL-C水平与入院时、术前ld、术后ld比较差异均有统计学意义(P＜0.05).结论 不稳定型心绞痛患者在介入术后MMP-9、IL-18水平明显升高,采取阿托伐他汀、氟伐他汀治疗能明显降低MMP-9、IL-18及血脂水平,两种药物降低MMP-9、IL-18效果相当,但氟伐他汀降脂效果更优. Objective To investigate the effect of atorvastatin and fluvastatin in unstable angina patients after intervention on matrix metalloproteinase-9 (MMP-9) and interleukin-18 (IL-18).Methods One hundred and four patients with unstable angina were divided into atorvastatin group and fluvastatin grourp with 52 cases each by random digits table.Atorvastatin group was given atorvastatin 10 mg/d,and fluvastatin group was given fluvastatin 40 mg/d for 6 weeks on the basis of conventional treatment.The change of blood fat,MMP-9 and IL-18 was observed in two groups.Results There was no significant difference in MMP-9 and IL-18 on admission,1 d before operation and 1 d or 6 weeks after operation between atorvastatin group and fluvastatin group (P ＞ 0.05).The level of MMP-9,IL-18 1 d after operation in atorvastatin group and fluvastatin group was higher than that on admission,1 d before operation [(328.47 +49.15) μg/L vs.(237.10 + 57.32),(235.97 + 56.24) μ g/L,(218.75 + 38.00) ng/L vs.(120.42 + 25.50),(115.22 + 28.93)ng/L and (330.42 ± 50.04) μ g/L vs.(235.98 ± 60.36),(236.29 ± 53.02) μ g/L,(220.16 ± 37.12) ng/L vs.(119.43 ± 24.85),(117.14 ± 26.80) ng/L] (P ＜ 0.05).The level of MMP-9,IL-18 6 weeks after operation was decreased in atorvastatin group and fluvastatin group [(152.28 ± 43.20) μ g/L,(101.36 ± 23.67) ng/L and (150.30 ± 44.18) μ g/L,(100.45 ± 24.58) ng/L],which had significant difference compared with that on admission,1 d before and after operation(P ＜ 0.05).There was no significant difference in triacylglycerol (TG),total cholesterol (TC),high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) on admission,1 d before and after operation between atorvastatin group and fluvastatin group (P ＞ 0.05).There was significant difference in TG,TC,HDL-C,LDL-C 6 weeks after operation between atorvastatin group and fluvastatin group [(2.05 ± 1.00),(5.15 ±0.61),(1.84 ±0.50),(3.13 ±0.88) mmol/L and (1.87 ± 1.05),(5.52 ± 0.84),(2.82 ± 0.57),(2.61 ± 0.79) mmol/L] (P ＜ 0.05).There was no significant difference in TG,TC,HDL-C,LDL-C 1 d after operation compared with that on admission,1 d before operation (P ＞ 0.05).There was significant difference in TG,TC,HDL-C,LDL-C 6 weeks after operation compared with that on admission,1 d before and after operation in atorvastatin group and fluvastatin group (P ＜0.05).Conclusions In unstable angina patients after intervention,MMP-9,IL-18 can significantly increase.Atorvastatin or fluvastatin therapy can obviously reduce the MMP-9,IL-18 and lipid level,but fluvastatin shows better effect.