摘要
目的探讨氯吡格雷联合阿托伐他汀对不稳定型心绞痛(UAP)患者血管内皮功能的保护作用。方法选取2017年5月~2018年7月就诊的UAP患者80例,随机分为观察组与对照组,各40例。两组均予以阿司匹林、肝素、硝酸酯类、β-受体阻滞剂和血管紧张素转换酶抑制剂等常规治疗。对照组在此基础上口服氯吡格雷75 mg/次,1次/d;观察组在对照组基础上再加阿托伐他汀钙片20 mg/次,1次/d,口服。两组疗程均4周。观察两组治疗前后血管内皮受指标[血清一氧化氮(NO)和内皮素-1(ET-1)]水平的变化,并比较其临床效果和不良反应。结果治疗4周后,两组血清NO水平较前显著上升,ET-1水平较前显著下降(P<0.05或P<0.01),且观察组上升或下降幅度较对照组更明显(P<0.05);同时观察组总有效率显著优于对照组(95.00%vs 80.00%)(χ^2=4.11,P<0.05)。对照组发生不良反应3例(7.50%),观察组5例(12.50%),症状相对较轻,两组相比差异无统计学意义(χ^2=0.14,P>0.05)。结论氯吡格雷与阿托伐他汀联合用于UAP患者的疗效肯定,安全性较好,其作用机制可能与其升高血清NO水平、降低ET-1水平、修复受损的血管内皮有关,具有保护血管内皮功能的作用。
Objective To explore the protective effect of clopidogrel combined with atorvastatin on vascular endothelial function in patients with unstable angina pectoris(UAP).Methods Eighty UAP patients who were treated from May 2017 to July 2018 were enrolled,and divided into the observation group and the control group,40 cases in each group.Both groups were treated with aspirin,heparin,nitrates,β-blockers and angiotensin-converting enzyme inhibitors as routine therapy.On this basis,patients in the control group were given clopidogrel 75 mg/time,once/d,orally;those in the observation group were additionally given atorvastatin calcium tablets 20 mg/time,once/d,orally.Both groups were treated for 4 weeks.The changes of vascular endothelium index[serum nitric oxide(NO)and endothelin-1(ET-1)]levels before and after treatment were observed,and the clinical effects and adverse reactions were compared.Results After 4 weeks of treatment,the serum NO level of the two groups increased significantly,and the level of ET-1 decreased significantly(P<0.05 or P<0.01),and the increase or decrease of the observation group was more obvious than the control group(P<0.05).At the same time,the total effective rate of the observation group was better than that of the control group(95.00%vs 80.00%)(χ^2=4.11,P<0.05).There were 3 cases(7.50%)of adverse reactions in the control group and 5 cases(12.50%)in the observation group,all with mild symptoms.There was no significant difference in the incidence of adverse reactions between the two groups(χ^2=0.14,P>0.05).Conclusion The efficacy of clopidogrel combined with atorvastatin in the treatment of UAP is clear and safe.The mechanism may be related to the increase of serum NO level,the decrease of ET-1 level,and the repair of damaged vascular endothelium to protect vascular endothelial function.
作者
黄丰
潘晨
周云芳
HUANG Feng;PANG Chen;ZHOU Yunfang(Department of Pharmacy,Lishui City People's Hospital in Zhejiang Province,Lishui323000,China)
出处
《中国现代医生》
2019年第36期92-95,共4页
China Modern Doctor
基金
浙江省医药卫生科技项目（2015KYB457）
