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目的:检测急性冠状动脉综合征(ACS)患者外周血中炎性细胞因子和高敏C反应蛋白,并观察早期使用阿托伐他汀对上述指标的影响,探讨他汀类药物治疗ACS的可能机制。方法:测定60例ACS患者、30例稳定型心绞痛(SA)患者和30例正常对照者的血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、干扰素γ(INF-γ)、可溶性细胞间黏附分子-1(sICAM-1)和高敏C反应蛋白(hs-CRP)以及TC、TG、HDL-C和LDL-C水平。并将60例ACS患者随机分为2亚组:他汀亚组和常规亚组,2亚组均予常规治疗,他汀亚组加服阿托伐他汀钙片。干预3周后对他汀亚组及常规亚组再次采血测定上述指标,比较2亚组药物干预后血清IL-6、TNF-α、INF-γ、sI-CAM-1、hs-CRP的变化以及与血脂变化的相关性。结果:ACS组IL-6、TNF-α、sICAM-1和hs-CRP水平均明显高于SA组及对照组,均差异有统计学意义,INF-γ水平差异无统计学意义;他汀亚组与常规亚组比较IL-6、TNF-α、sICAM-1和hs-CRP治疗后明显下降,差异有统计学意义。他汀亚组IL-6、TNF-α、sICAM-1及hs-CRP的下降与血脂下降无关。结论:测定血清IL-6、TNF-α、sICAM-1和hs-CRP水平可了解炎症反应的强度。阿托伐他汀具有独立于降脂作用之外的抗炎症反应作用,此作用可能是稳定易损斑块的早期机制之一。
Objective: To detect the levels of inflammatory cytokines and high-sensitivity C-reactive protein in peripheral blood of patients with acute coronary syndrome (ACS) and to observe the effect of atorvastatin on the above indexes in early stage and to explore the possible mechanism of statins in the treatment of ACS. Methods: The levels of serum interleukin-6, tumor necrosis factor-α (TNF-α), interferon-γ (INF-γ), soluble intercellular adhesion molecule-1 (sICAM-1) and high sensitivity C-reactive protein (hs-CRP), as well as TC, TG, HDL-C and LDL- Sixty patients with ACS were randomly divided into 2 subgroups: statin subgroup and routine subgroup, subgroup 2 received routine treatment, and statin subgroup plus atorvastatin calcium tablet. After three weeks of intervention, the above indexes were determined again by statins subgroups and conventional subgroups. The changes of serum IL-6, TNF-α, INF-γ, sI-CAM-1 and hs- Correlation with changes in blood lipids. Results: The levels of IL-6, TNF-α, sICAM-1 and hs-CRP in ACS group were significantly higher than those in SA group and control group, the difference was statistically significant, but there was no significant difference in INF- The levels of IL-6, TNF-α, sICAM-1 and hs-CRP were significantly decreased after treatment compared with the routine subgroup, with significant difference. The statin subgroup IL-6, TNF-α, sICAM-1 and hs-CRP decline has nothing to do with the decline in blood lipids. Conclusion: The levels of serum IL-6, TNF-α, sICAM-1 and hs-CRP can be measured to understand the intensity of inflammatory reaction. Atorvastatin has anti-inflammatory effects independent of lipid-lowering effects, and this effect may be one of the early mechanisms of stabilizing vulnerable plaque.