目的 探讨葛根素注射液对急性冠脉综合征(ACS)患者相关内皮损伤、炎症、免疫指标的影响.方法 将84例ACS按患者随机原则分为常规治疗组(对照组,38例)、葛根素注射液组(治疗组,46例);对照组给予常规治疗;治疗组在对照组基础上给予葛根素注射液600 mg静脉滴注,两组均治疗20 d.观察治疗后血清内皮素(ET)、一氧化氮(NO)、可溶性血管细胞黏附分子-1(sVCAM-1)、可溶性细胞间黏附分子-1(ICAM-1)、氧化低密度脂蛋白(ox-LDL)、基质金属蛋白酶-9(MMP-9)、可溶性P-选择素、白细胞介素-18(IL-18)含量的变化.结果 ①治疗组和对照组组治疗后血清ET含量明显低于治疗前(P＜0.01),NO含量明显高于治疗前(P＜0.01);治疗组sVCAM-1、sICAM-1含量明显低于治疗前(P＜0.01),且治疗组血清ET、sVCAM-1、sICAM-1含量降低程度较对照组明显[ET(pg/L):10.85±14.21比16.11±13.93,sVCAM-1(μg/L):532±163比695±191,siCAM-1(μmol/L):3.70±1.76比5.52±1.66,均P＜0.01],NO升高程度较对照组明显[NO(μmol/L):78.7±11.3比52.6±8.9,P＜0.05].②两组治疗后血清P-选择素、MMP-9、IL-18含量均显著降低(均P＜0.01),且治疗组下降程度较对照组明显[P-选择素(μg/L):5.2±2.6比7.6±2.8,MMP-9(ng/L):0.80±0.45比1.87±0.42,IL-18(ng/L):63.35±40.31比83.54±39.19,均P＜0.05].两组ox-LDL治疗后无明显变化(均P＞0.05).结论 葛根素注射液可能通过多环节影响ACS患者相关内皮损伤、炎症、免疫指标,改善血管内皮功能,从而达到对血管内皮的保护作用.%Objective To discuss the effect of Puerarin injection (葛 根 素 注 射 液) on endothelial injury,inflammation, immune and cytokines in patients with acute coronary syndrome (ACS). Methods Eighty-four patients with ACS were randomly divided into two groups: conventional treatment group (control group,n=38) and Puerarin injection group (treatment group, n = 46). All patients in both groups were given the conventional treatment (standard therapy), and those in treatment group additionally received intravenous infusion of Puerarin injection 600 mg. The therapeutic course in both groups was 20 days. After treatment the changes of the contents of serum endothelin (ET), nitric oxide (NO), soluble vascular cell adhesion molecule-1 (sVCAM-1) and soluble intercellular adhesion molecule-1 (sICAM-1), oxidized low density lipoprotein (ox-LDL), matrix metalloproteinase9 (MMP-9) ,soluble P-selectin and interleukin-18(IL-18) were observed. Results ① The serum levels of ET in treatment group and control group were significantly decreased (P＜0. 01), however, the serum levels of NO in the two groups were obviously higher than those before treatment (P＜ 0. 01); the serum levels of sVCAM-1, sICAM-1 were markedly reduced in the treatment group (P＜0. 01), and the degrees of descent in serum levels of ET, sVCAM-1, sICAM-1 in the treatment group were obviously greater compared with those in the control group [ET (pg/L): 10.85 ±14.21 vs. 16. 11±13. 93, sVCAM-1 (μg/L): 532±163 vs. 695±191, sICAM-1 (μmol/L): 3.70±1.76 vs. 5.52±1.66, all P＜0. 01], while the degree of NO increase in the treatment group was higher significantly than that in the control group [NO (μmol/L): 78.7±11.3 vs. 52.6±8.9, P＜0.05]. ② The serum levels of P-selectin, MMP-9 and IL-18 were significantly reduced in both groups after treatment (all P＜0. 01), and in the treatment group, they decreased more obviously than those in the control group [P-selectin (μg/L): 5.2±2.6 vs. 7. 6±2.8, MMP-9(ng/L): 0.80±0.45vs. 1.87±0.42, IL-18 (ng/L): 63.35±40. 31 vs. 83.54±39. 19, all P＜ 0. 05]. There was no change of ox-LDL in serum level after treatment in both groups (P＞0. 05). Conclusion Puerarin injection via multiple links can affect endothelium injury, inflammation,immune and cytokines in patients with ACS to improve vascular endothelial functions and in turn protecting the endothelium.
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