冯培峰 赖志斌 邓明玉

【摘要】 目的 探討不同剂量辛伐他汀治疗急性冠状动脉综合征（ACS）对患者脂蛋白相关磷脂酶A2（LP-PLA2）及超敏C反应蛋白（hs-CRP）的影响。方法 120例ACS患者， 采用数字随机法分为低剂量组、中剂量组和高剂量组， 各40例。所有患者均进行常规基础治疗， 低剂量组患者另给予10 mg/d辛伐他汀治疗， 中剂量组患者给予20 mg/d辛伐他汀治疗， 高剂量组患者给予40 mg/d辛伐他汀治疗， 比较三组患者治疗前后血脂、LP-PLA2、hs-CRP水平变化情况及用药安全性。结果 治疗1、2周后， 三组患者甘油三酯、胆固醇、低密度脂蛋白胆固醇水平均低于治疗前， 高密度脂蛋白胆固醇水平均高于治疗前， 差异有统计学意义（P<0.05）。治疗2周后， 高剂量组患者甘油三酯、胆固醇、低密度脂蛋白胆固醇水平均低于中剂量组， 中剂量组患者甘油三酯、胆固醇、低密度脂蛋白胆固醇水平均低于低剂量组， 差异有统计学意义（P<0.05）；中剂量组患者高密度脂蛋白胆固醇水平与高剂量组和低剂量组比较差异无统计学意义（P>0.05）。治疗1、2周后， 三组患者LP-PLA2水平均低于治疗前， 差异有统计学意义（P<0.05）。治疗2周后， 高剂量组患者LP-PLA2水平低于中剂量组， 中剂量组患者LP-PLA2水平低于低剂量组， 差异均有统计学意义（P<0.05）。治疗1、2周后， 三组患者hs-CRP水平均低于治疗前， 差异有统计学意义（P<0.05）。治疗2周后， 高剂量组患者hs-CRP水平低于中剂量组， 中剂量组患者hs-CRP水平低于低剂量组， 差异有统计学意义（P<0.05）。治疗2周后， 三组患者谷丙转氨酶、谷草转氨酶水平均与治疗前比较差异无统计学意义（P>0.05）。高剂量组患者用药不良反应发生率（2.5%）与低剂量组（0）、中剂量组（0）比较差异无统计学意义（P>0.05）。结论 实施辛伐他汀治疗ACS可降低患者LP-PLA2及hs-CRP水平， 且实施40 mg/d高剂量治疗效果优于中、低剂量， 用药效果及安全性均较高。

【关键词】 辛伐他汀；急性冠状动脉综合征；血脂；脂蛋白相关磷脂酶A2；超敏C反应蛋白

DOI：10.14163/j.cnki.11-5547/r.2018.10.001

【Abstract】 Objective To discuss the effect of different doses of simvastatin on lipoprotein-associated phospholipase A2 （LP-PLA2） and hypersensitivity C reactive protein （hs-CRP） during the treatment of acute coronary syndrome （ACS）. Methods A total of 120 ACS patients were divided by random number method into low dose group， medium dose group and high dose group， with 40 cases in each group. All patients were treated with routine basic treatment， and low dose group also treated with simvastatin by 10 mg/d， while medium dose group treated with simvastatin by 20 mg/d and high dose group treated with simvastatin by 40 mg/d. The changes of blood lipid， LP-PLA2， hs-CRP and medication safety were compared before and after treatment between the three groups. Results After 1 and 2 weeks of treatment， three groups had lower triglyceride， cholesterol and low density lipoprotein cholesterol than before treatment， and higher high density lipoprotein cholesterol level than before treatment. Their difference was statistically significant （P<0.05）. After 2 weeks of treatment， high dose group had lower triglyceride， cholesterol and low density lipoprotein cholesterol than medium dose group， and medium dose group had lower triglyceride， cholesterol and low density lipoprotein cholesterol. Their difference was statistically significant （P<0.05）. Medium dose group had no statistically significant difference in high density lipoprotein cholesterol level comparing with high dose group and low dose group （P>0.05）. Before treatment， three groups had no statistically significant difference in LP-PLA2 level （P>0.05）. After 1 and 2 weeks of treatment， three groups had lower LP-PLA2 than before treatment， and the difference was statistically significant （P<0.05）. After 2 weeks of treatment， high dose group had lower LP-PLA2 level than medium dose group， and medium dose group had lower LP-PLA2 level than low dose group. Their difference was statistically significant （P<0.05）. After 1 and

2 weeks of treatment， three groups had lower hs-CRP level than before treatment， and the difference was statistically significant （P<0.05）. After 2 weeks of treatment， high dose group had lower hs-CRP level than medium dose group， and medium dose group had lower hs-CRP level than low dose group. Their difference was statistically significant （P<0.05）. After 2 weeks of treatment， three groups had no statistically significant difference in alanine aminotransferase， aspartate aminotransferase levels comparing with before treatment （P>0.05）. High dose group had no statistically significant difference in incidence of adverse medication reactions （2.5%） comparing with low dose group （0） and medium dose group （0） （P>0.05）. Conclusion Implementation of simvastatin in treating ACS can lower the LP-PLA2 and hs-CRP level， and high dose of 40 mg/d shows higher medication effect and safety than medium and low dose.

【Key words】 Simvastatin； Acute coronary syndrome； Lipid； Lipoprotein-associated phospholipase A2； Hypersensitivity C reactive protein

急性冠状动脉综合征（acute coronary syndrome， ACS）是目前临床较为严重的心血管疾病类型， 也是冠心病的重要类型。目前临床研究显示， 动脉粥样硬化（atherosclerosis， AS）是ACS发生的病理基础， 冠状动脉粥样硬化斑块破裂后， 将引起冠状动脉血栓形成、冠状动脉完全或不完全闭塞， 进而诱发ACS发生， 并直接影响冠心病患者预后状况[1， 2]。相关研究报道提出炎症反应在ACS发生过程中具有重要作用 [3-5]。脂蛋白相关磷脂酶A2（lipoprotein-associated phospholipase A2， LP-PLA2）是血管特异性炎症标志物， 研究证实LP-PLA2在冠心病发生中具有重要作用。超敏……