富萍,裴晓冬,刘永,孙奡燕
FU Ping,PEI Xiao-dong,LIU Yong,SUN Ao-yan(Department of Cardiology

• 1:沈阳医学院奉天医院心内科

摘要(Abstract)：

目的探讨瑞舒伐他汀联用雷米普利对急性心肌梗死(acute myocardial infarction,AMI)患者血清hs-CRP及MMP-9水平的影响。方法选取AMI患者65例,随机分为2组:A组(n=32)给予瑞舒伐他汀(20 mg·d-1),B组(n=33)用瑞舒伐他汀(20 mg·d-1)联合雷米普利(5 mg·d-1)治疗,2组疗程均为6个月,观察心血管事件发生情况,并设健康对照组(n=30)。测定治疗前后血清中hs-CRP和MMP-9的水平,超声心动图检查,并进行统计学分析。结果 AMI组中血清hs-CRP和MMP-9的水平明显高于对照组(P<0.01);B组在治疗后血清MMP-9的水平明显降低(P<0.01),左室重构发生率低(P<0.01),再发心血管事件也有下降趋势。结论 AMI后给予瑞舒伐他汀联用雷米普利治疗能减少冠状动脉粥样斑块基质成分的降解,达到稳定动脉粥样硬化斑块的作用,改善患者预后。
Objective To observe the influence of the different doses of rosuvastatin with ramipril on serum hs-CRP,MMP-9 in the patients with acute myocardial infarction.Methods Sixty five patients with AMI were randomly assigned to rosuvastatin(20 mg·d-1)group(A group,n=32)and rosuvastatin(20 mg·d-1)with ramipril(5 mg·d-1)group(B group,n=33).Thirty healthy subjects were selected as the control group.Before and after treatment,the serum levels of hs-CRP and MMP-9 and parameters of left ventricular remodeling were compared among treatment groups and control group,and the primary end point events were observed and compared between the two treatment groups.Results Serum levels of hs-CRP and MMP-9 were significant higher in the AMI group than that in the control group(P<0.01).B group had a significantly decrease in serum level of MMP-9(P<0.01)and left ventricular remodeling(P<0.01),and less tendency of primary end point events.Conclusions Rosuvastatin combined with ramipril in the AMI patients can reduce coronary artery atheromatous plaque matrix degradation,achieve the stabilization of atherosclerotic plaque function,and improve the prognosis.

关键词(KeyWords)： 急性心肌梗死;瑞舒伐他汀;他汀;雷米普利;血管紧张素转换酶抑制剂;基质金属蛋白酶-9;高敏C-反应蛋白
acute myocardial infarction;rosuvastatin;statins;ramipril;angiotensin-converting enzyme inhibitor;high sensitivity C-reactive protein;matrix metalloproteinase 9

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 富萍,裴晓冬,刘永,孙奡燕
FU Ping,PEI Xiao-dong,LIU Yong,SUN Ao-yan(Department of Cardiology

DOI: 10.14066/j.cnki.cn21-1349/r.2013.01.005

参考文献(References)：

• [1]SUZUKI M,SAITO M,NAGAI T,et a1.Systemic versuscoronary levels of inflammation in acute coronary syn-dromes[J].Angiology,2006,57(4):459-463.
• [2]ZENG B,PRASAN A,FUNG K C,et a1.Elevated cir-culating levels of matrix metalloproteinase-9 and-2 inpatients with symptomatic coronary artery disease[J].Intern Med J,2005,35:331.
• [3]KOERIG W.Inflammation and coronary heart disease:an overview[J].Cardio Rev,2001,9:31-35.
• [4]MORISHIGE K,SHIMOKAWA H,MATSUMOTO Y,etal.Overexpression of matrix metalloproteinase-9 pro-motes intravascular thrombus formation in porcine coro-nary arteries in vivo[J].Cardiovasc Res,2003,57(2):572-585.
• [5]陈样新,傅国胜,徐耕,等.血清基质金属蛋白酶与急性冠脉综合征的相关性研究[J].中华心血管病杂志,2005,33(1):25.
• [6]FUKUDA D,SHIMADA K,FANAKA A,et a1.Compar-ison of 1evels of serum matrix metal1oproteinase-9 inpatients with acute myocardial infarction versus unsta-ble angina pectoris versus stable angina pectoris[J].Am J Cardiol,2006,97(2):175.
• [7]ZHANG X W,GE J B,YANG J M,et a1.Relationshipbetween hs-CRP,proMMP-1,TIMP-1 and coronaryplaque morphology:intravascular ultrasound study[J].Chin Med J(Eng1),2006,119(20):1689.
• [8]殷忠,李兰荪,张荣庆.冠心病患者外周血MMP-9、CRP的变化及其临床意义[J].中国康复医学杂志,2006,21(4):3l8-321.
• [9]郑婕,田建会,丁思华.阿托伐他汀对急性冠状动脉综合征病人炎症因子影响[J].青岛大学医学院学报,2008,44(2):153-155.
• [10]梁伟,杨晖,吴春芳,等.不同调脂方案对冠心病患者基质金属蛋白酶的影响[J].中华心血管病杂志,2009,37(5):417-421.
• [11]NISSEN S E,NICHOLLS S J,SIPAHI I,et a1.Effect ofvery high-intensity statin therapy on regression of coro-nary atheroscleosis:the ASTEROID trial[J].JAMA,2006,295(13):1556-1565.
• [12]SIPAHI I,TUZCU E M,SEHOENHAGEN P,et al.Par-adoxical increase in lumen size during progression ofcorollary atherosclerosis:observations from the REVER-SAL trim[J].Atherosclerosis,2006,189(1):229-235.
• [13]REINHARDT D,SIGUSEH H H,HENSSE J,et a1.Cardiac remodeling in end stage heart failure:up regu-lation of matrix metal1oproteinase(MMP)irrespective ofthe underlying disease,and evidence for a direct inhibi-tory effect of ACE inhibitors on MMP[J].Heart,2002,88(5):525-530.
• [14]王玲,周颖玲,陈纪言,等.雷米普利和伊贝莎坦改善炎症标志物近期疗效[J].岭南心血管病杂志,2005,11(4):231-234.
• [15]YAMAMOTO D,TAKAI S,JIN D,et a1.Molecularmechanism of imidapril for cardiovascular protection viainhibition of MMP-9[J].J Mol Cell Cardiol,2007,43(6):670-676.
• [16]BROWER G L,LEVICK S P,JANICKI J S.Inhibitionof matrix metalloproteinase activity by ACE inhibitorsprevents left ventricular remode1ing in a rat model ofheart failure[J].Am J Physiol Heart Circ Physiol,2007,292(6):3057-3064.
• [17]TRAKAI S,YAMAMOTO D,JIN D,et a1.Inhibition ofmatrix metallopro-teinase-9 activity by lisinopril aftermyocardial infarction in ham stets[J].Eur J Pharmae-ol,2007,568(1/2/3):231-233.