曲美他嗪联合氯吡格雷对冠心病患者颈总动脉粥样硬化斑块及炎症因子的影响

杨莉; 孙晓慧; 贺静; 乌宇亮

doi:10.7619/jcmp.201911006

曲美他嗪联合氯吡格雷对冠心病患者颈总动脉粥样硬化斑块及炎症因子的影响

1.
长庆油田职工医院, 陕西西安, 710201
2.
西安交通大学第一附属医院心血管内科, 陕西西安, 710061

详细信息

通讯作者:
贺静

中图分类号: R541.4
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出版历程
- 收稿日期: 2019-04-12
- 录用日期: 2019-05-16
- 网络出版日期: 2021-02-22
- 发布日期: 2019-06-14

Influence of trimetazidine combined with clopidogrelon carotid atherosclerotic plaques and inflammatory factors of patients with coronary heart disease

1.
The Worker′s Hospital of Changqing Oil Field, Xi′an, Shaanxi, 710201
2.
Department of Cardiovascular Internal Medicine, The First Affiliated Hospital of Xi′an Jiaotong University, Xi′an, Shaanxi, 710061

摘要

摘要:
目的探讨曲美他嗪联合氯吡格雷对冠心病患者颈总动脉粥样硬化斑块及炎症因子的影响。
方法将126例冠心病患者随机分为曲美他嗪组、氯吡格雷组及联合治疗组。3组患者均接受常规治疗, 曲美他嗪组加服曲美他嗪，氯吡格雷组加服氯吡格雷，联合治疗组加服曲美他嗪联合氯吡格雷。比较3组患者治疗前及治疗6个月后血管内中膜厚度(IMT)、颈总动脉粥样硬化斑块面积、斑块直径及斑块厚度; 比较3组患者实验室指标[肿瘤坏死因子-α(TNF-α)、超敏C反应蛋白(hs-CRP)、一氧化氮(NO)、人内皮素-1(ET-1)]及疗效。
结果治疗后，氯吡格雷组患者IMT、颈总动脉粥样硬化斑块体积、斑块直径及斑块厚度均显著小于曲美他嗪组(P < 0.01), 联合治疗组患者IMT、颈总动脉粥样硬化斑块体积、斑块直径及斑块厚度均显著小于其他2组(P < 0.01)。曲美他嗪组患者血清TNF-α、hs-CRP及ET-1水平均显著低于氯吡格雷组，血清NO水平显著高于氯吡格雷组(P < 0.01); 联合治疗组患者血清TNF-α、hs-CRP及ET-1水平均显著低于其他2组，血清NO水平显著高于其他2组(P < 0.01)。联合治疗组患者总有效率97.60%, 显著高于曲美他嗪组83.30%及氯吡格雷组81.00% (P < 0.05)。
结论在冠心病患者中联合应用曲美他嗪及氯吡格雷的治疗效果显著，可明显缩小患者颈总动脉粥样硬化斑块，降低血清TNF-α及hs-CRP水平，改善患者的血管内皮功能，改善患者预后。
- 曲美他嗪 /
- 氯吡格雷 /
- 冠心病 /
- 颈总动脉粥样硬化斑块 /
- 炎症因子
Abstract:
Objective To investigate the effect of trimetazidine combined with clopidogrel on carotid atherosclerotic plaques and inflammatory factors of patients with coronary heart disease.
Methods Totally 126 patients with coronary heart disease were randomly divided into trimetazidine group, clopidogrel group and combined treatment group. Patients in the three groups received routine treatment. Trimetazidine group was given trimetazidine, clopidogrel group was given clopidogrel, and combined treatment group was given trimetazidine and clopidogrel. The intima-media thickness (IMT), carotid atherosclerotic plaque area, plaque diameter and plaque thickness of the three groups were compared before treatment and 6 months after treatment, and the laboratory indexes [tumor necrosis factor-α (TNF-α), hypersensitive C-reactive protein (hs-CRP), nitric oxide (NO), human endothelin-1 (ET-1)] and therapeutic effect of the three groups were compared.
Results After treatment, IMT, plaque volume, plaque diameter and plaque thickness in clopidogrel group were significantly smaller than those in trimetazidine group (P < 0.01), while IMT, plaque volume, plaque diameter and plaque thickness in combined treatment group were significantly smaller than those in other two groups (P < 0.01). The serum levels of TNF-α, hs-CRP and ET-1 in trimetazidine group were significantly lower than those in clopidogrel group, and the serum NO level was significantly higher than that in clopidogrel group (P < 0.01). The serum levels of TNF-α, hs-CRP and ET-1 in combined treatment group were significantly lower than those in other two groups, and the serum NO level was significantly higher than that in other two groups (P < 0.01). The total effective rate of combined treatment group was 97.60%, which was significantly higher than 83.30% of trimetazidine group and 81.00% of clopidogrel group (P < 0.05).
Conclusion Trimetazidine combined with clopidogrel is effective in the treatment of patients with coronary heart disease, which can significantly reduce carotid atherosclerosis plaque, reduce serum levels of TNF-α and hs-CRP, improve vascular endothelial function and improve prognosis of patients.
- trimetazidine /
- clopidogrel /
- coronary heart disease /
- carotid atherosclerotic plaques /
- inflammatory factors

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表 1 3组患者治疗前后IMT、颈总动脉粥样硬化斑块体积、斑块直径及斑块厚度比较(x±s)

指标	时点	曲美他嗪组(n=42)	氯吡格雷组(n=42)	联合治疗组(n=42)
IMT/mm	治疗前	2.40±0.32	2.38±0.30	2.30±0.25
	治疗后	2.17±0.19^**##△△	2.03±0.21^**##	1.68±0.16^**
斑块面积/mm²	治疗前	35.40±7.82	37.45±8.04	36.07±7.19
	治疗后	30.90±4.62^**##△△	26.76±4.33^**##	21.49±4.64^**
斑块直径/mm	治疗前	4.98±1.05	4.68±0.90	4.83±1.21
	治疗后	4.38±0.61^**##△△	4.04±0.77^**##	3.68±0.54^**
斑块厚度/mm	治疗前	2.33±0.60	2.28±0.76	2.23±0.55
	治疗后	2.03±0.21^**##△△	1.90±0.28^**##	1.68±0.16^**
IMT: 血管内中膜厚度。与治疗前比较, **P < 0.01; 与联合治疗组比较, ##P < 0.01; 与氯吡格雷组比较, △△P < 0.01。

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表 2 3组患者治疗前后血清TNF-α、hs-CRP、NO及ET-1水平比较(x±s)

指标	时点	曲美他嗪组(n=42)	氯吡格雷组(n=42)	联合治疗组(n=42)
TNF-α/(ng/L)	治疗前	45.20±6.91	44.67±6.16	44.89±7.28
	治疗后	31.21±5.58^**##△△	35.65±4.68^**##	25.64±4.23^**
hs-CRP/(mg/L)	治疗前	8.28±1.76	8.01±1.85	8.67±1.82
	治疗后	3.91±1.11^**##△△	4.70±1.24^**##	2.72±1.12^**
NO/(μmol/L)	治疗前	55.40±6.90	54.79±5.73	54.70±7.32
	治疗后	64.86±7.14^**##△△	59.81±7.68^**##	69.88±9.11^**
ET-1/(ng/L)	治疗前	110.67±15.59	108.59±15.66	112.68±16.86
	治疗后	81.51±11.71^**##△△	88.96±11.86^**##	74.32±9.00^**
TNF-α: 肿瘤坏死因子-α; hs-CRP: 超敏C反应蛋白; NO: 一氧化氮; ET-1: 人内皮素-1。与治疗前比较, **P < 0.01; 与联合治疗组比较, ##P < 0.01; 与氯吡格雷组比较, △△P < 0.01。

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表 3 3组患者的临床疗效[n(%)]

组别	显效	有效	无效	总有效
曲美他嗪组(n=42)	21(50.00)	14(33.30)	7(16.70)	35(83.30)^*
氯吡格雷组(n=42)	23(54.80)	11(26.20)	8(19.00)	34(81.00)^*
联合治疗组(n=42)	29(69.00)	11(26.20)	1(2.40)	41(97.60)
与联合治疗组比较, *P < 0.05。

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