普罗布考联合阿托伐他汀对ACS患者PCI术后ox-LDL及Lp-PLA2水平的影响

摘要

Objective To evaluate the effects of probucol combined with atorvastatin medication on blood levels of oxidized low-density lipoprotein (ox-LDL), lipoprotein-associated phospholipase A2 (Lp-PLA2), and the correlation of their changes in patients with acute coronary syndrome (ACS) undergoing percutaneous poronary intervention (PCI). Methods A total of 97 patients with ACS and undergoing PCI were randomly divided into two groups according to the date of admission:single medication group (n=42),the patients were taken atorvastatin 20 mg/d; and combined medication group (n=55),the patients were taken atorvastatin 20 mg/d with probucol 500 mg/d. The plasma levels of ox-LDL and Lp-PLA2 were measured in both groups before and 6-8 weeks after the medication. Then the results were compared and analyzed between two groups. Results (1) Before treatment there were no significant differences in levels of ox-LDL and Lp-PLA2 between two groups (P>0.05). After the treatment, the ox-LDL level was significantly decreased in combined medication group (P<0.01). After the treatment, the levels of Lp-PLA2 were significantly decreased than those before treatment in both groups (P<0.01). Compared with single medication group, levels of ox-LDL and Lp-PLA2 were significantly lower in combined medication group (P < 0.01). (2) After treatment, the absolute value of Lp-PLA2 decline (ΔLp-PLA2) was positively correlated with the absolute value of ox-LDL decline (Δox-LDL) in combined medication group (r=0.314, P=0.020). Conclusion Probucol combined with statin therapy can reduce ox-LDL and Lp-PLA2 levels, and with a positive correlation between them. Probucol can further decrease the level of Lp-PLA2 by inhibiting ox-LDL production, which may be one of the mechanisms of its anti-atherosclerosis.%目的：观察急性冠脉综合征（ACS）行冠状动脉介入治疗（PCI）术的患者联合应用普罗布考和阿托伐他汀治疗后，循环中氧化型低密度脂蛋白（ox-LDL）及脂蛋白相关磷脂酶A2（Lp-PLA2）水平的变化及其相互关系。方法97例行PCI的ACS患者依据入院日期分为单药组（42例，单日入院者）和联合组（55例，双日入院者）。在常规治疗基础上，单药组予以阿托伐他汀（20 mg/次，1次/d）治疗；联合组在单药组基础上再予以普罗布考（250 mg/次，2次/d）联合治疗，分别于治疗前及治疗后6～8周采用酶联免疫吸附试验（ELISA）检测血Lp-PLA2、ox-LDL水平，分别进行组间比较及治疗前后比较。结果（1）2组治疗前ox-LDL、Lp-PLA2水平差异无统计学意义。联合组治疗后ox-LDL水平较治疗前下降（P＜0.01）。2组治疗后Lp-PLA2水平均较治疗前下降，治疗后联合组ox-LDL和Lp-PLA2水平均低于单药组（P＜0.01）。（2）联合组患者治疗前后Lp-PLA2的下降绝对值（ΔLp-PLA2）与ox-LDL的下降绝对值（Δox-LDL）呈正相关（r=0.314，P=0.020）。结论普罗布考联合阿托伐他汀治疗能有效降低ACS患者ox-LDL和Lp-PLA2水平，并且二者的下降幅度呈正相关，普罗布考通过抑制ox-LDL的生成进一步降低Lp-PLA2水平可能是其抗动脉粥样硬化的机制之一。