阿托伐他汀联合氯吡格雷治疗冠心病心绞痛的临床疗效

摘要

目的 观察阿托伐他汀联合氯吡格雷治疗冠心病心绞痛的临床疗效.方法 选取青海省心脑血管病专科医院心血管内科2014年5月—2016年10月收治的冠心病心绞痛患者138例,按照随机数字表法分为常规组和观察组,每组69例.常规组患者给予常规治疗,观察组患者在常规组治疗基础上给予阿托伐他汀联合氯吡格雷治疗;两组患者均连续治疗3个月.比较两组患者临床疗效,治疗前后血脂指标、心功能指标及血清组织型纤溶酶原激活物抑制剂1 (tPAI-1)、单核细胞趋化因子1(MCP-1)、可溶性E-选择素(sE-selectin)水平,并观察两组患者治疗期间不良反应发生情况.结果 观察组患者临床疗效优于常规组(P＜0.05).治疗前两组患者三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)及高密度脂蛋白胆固醇(HDL-C)水平比较,差异无统计学意义(P＞0.05);治疗后观察组患者TG、TC及LDL-C水平低于常规组,HDL-C水平高于常规组(P＜0.05).治疗前两组患者心脏指数(CI)、心脏每分搏出量(CO)及射血分数(EF)比较,差异无统计学意义(P＞0.05);治疗后观察组患者CI、CO及EF高于常规组(P＜0.05).治疗前两组患者血清-tPAI-1、MCP-1及sE-selectin水平比较,差异无统计学意义(P＞0.05);治疗后观察组患者血清tPAI-1、MCP-1及sE-selectin水平低于常规组(P＜0.05).治疗期间,常规组患者发生尿道出血1例、皮下出血1例,观察组患者发生皮下出血1例;两组患者均未发生严重出血、血小板减少及过敏反应.结论 阿托伐他汀联合氯吡格雷能有效提高冠心病心绞痛患者临床疗效,改善患者血脂代谢、心功能及纤溶状态,减轻炎性反应,且安全性较高.%Objective To observe the clinical effect of atorvastatin combined with clopidogrcl in treating coronary heart disease patients with angina pectoris.Methods From May 2014 to October 2016,a total of 138 coronary heart disease patients with angina pectoris were selected in the Department of Cardiovascular Medicine,Cardiovascular and Cerebrovascular Disease Specialized Hospital of Qinghai Province,and they were divided into control group and observation group,each of 69 cases.Patients of control group received conventional treatment,while patients of observation group received atorvastatin combined with clopidogrel based on conventional treatment;both groups continuously treated for 3 months.Clinical effect,blood lipids index,index of cardiac function,serum levels of tPAI-1,MCP-1 and sE-selectin before and after treatment were compared between the two groups,and incidence of adverse reactions was observed during the treatment.Results Clinical effect of observation group was statistically significantly better than that of control group (P ＜ 0.05).No statistically significant differences of TG,TC,LDL-C or HDL-C was found between the two groups before treatment (P ＞ 0.05);after treatment,TG,TC and LDL-C of observation group wer statistically significantly lower than those of control group,while HDL-C of observation was statistically significantly higher than that of control group (P ＜ 0.05).No statistically significant differences of CI,CO or EF was found between the two groups before treatment (P ＞0.05),while CI,CO and EF of observation group were statistically significantly higher than those of control group (P ＜ 0.05).No statistically significant differences of serum level of tPAI-1,MCP-1 or sE-selectin was found between the two groups before treatment (P ＞0.05),while serum levels of tPAI-1,MCP-1 and sE-selectin of observation group were statistically significantly lower than those of control group (P ＜ 0.05).During the treatment of control group,1 case occurred urethremorrhage,1 case occurred subcutaneous hemorrhage,while 1 case of observation group occurred subcutaneous hemorrhage;no one of the two groups occurred severe hemorrhage,thrombocytopenia or anaphylaxis.Corclusion Atorvastatin combined with clopidogrel can effectively improve the clinical effect,blood lipid metabolism,cardiac function and fibrinolytic function of coronary heart disease patients with angina pectoris,is helpful to relieve the inflammatory reaction,and is relatively safe.