| ObjectiveThe study will evaluate the effect of different doses of fluvastatin and fluvastatin-probucol combined therapy on levels of serum lipid, high sensitivity C-reactive protein(hs-CRP), placenta growth factor(PLGF) and oxidized low-density lipoprotein(ox-LDL), and investigate the efficacy of various therapy protocols in patients with acute coronary syndrome(ACS). In additional, the study will explore the clinical status of combination therapy in the treatment of ACS.MethodsNinety-five patients were selected, who had performed coronary angiography in the department of cardiology, Tianjin People’s Hospital, from October2010to May2011. Among them,60patients were diagnosed as ACS (including28patients with unstable angina pectoris and32patients with acute mycardical infarction), and the remainder with no CAD evidenced by CAG acted as control group. Sixty patients with ACS were further subdivided into three groups randomly,20patients in each group. All of the patients were received standard treatment. The patients of group A were taken fluvastatin40mg/d; the patients of group B were taken fluvastatin80mg/d; and the patients of group C were taken fluvastatin40mg/d and250mg of probucol twice a day. The venous blood was collected before treatment to examine the serum levels of biomarkes, including total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), hs-CRP, PLGF, ox-LDL, CK, hepatorenal function and blood routine. Compared the baseline levels of serum hs-CRP, PLGF and ox-LDL in the ACS group with those in the control group, explored the potential role of these biomarkers in ACS. Three months treatment later, all of the above biomakers were reexamined. After that, the changes of various biomarker levels in each group and between the three groups were analyzed after3months treatment. At the same time, the drug side effects were detected.Results1. The baseline levels of serum hs-CRP, PLGF and ox-LDL in the ACS group were significantly higher than those in the control group (P<0.001). In the subgroup analysis:The levels of hs-CRP and PLGF in the AMI and UAP groups were obviously higher than those in the control group (P<0.001). As compared AMI group with UAP group, AMI patients had an even higher level of serum PLGF (P<0.05), but there was no significant differences between the two groups in the level of serum hs-CRP.2. Pearson correlation analysis showed that there was a significant positive correlation between the levels of serum hs-CRP and PLGF in the ACS group (r=0.426, P<0.01), but no correlation were observed between the levels of serum ox-LDL and hs-CRP or PLGF (P>0.05).3. The serum lipid levels in each group:Compared with the pretreatment values, the levels of TC, TG and LDL-C in the group B and C were significantly decreased (P<0.05), but the level of HDL-C was not obviously changed(P>0.05). The levels of TC and LDL-C in the group A were decreased before and after3months treatment, but there were no significant differences (P>0.05).4. The serum lipid levels between three groups after3months treatment:The levels of serum lipid (TC. TG, HDL-C and LDL-C) in group C were significantly lower than group A (P<0.05). Except the levels of TG. HDL-C and LDL-C, TC level in group C was also obviously lower than that in group B (P<0.05). In addition, There were no significant differences in the levels of serum lipid between group A and group B after3months treatment (P>0.05).5. The serum inflammatory factors levels in each group:Compared with the pretreatment values, the levels of hs-CRP and PLGF in each group were significantly decreased (P<0.01), and ox-LDL level in group C was also obviously decreased after3months treatment (P<0.01), but there was no significant difference in the level of serum ox-LDL between group A and group B (P>0.05).6. The serum inflammatory factors levels between three groups after treatment:After the3months follow-up, the levels of serum hs-CRP and PLGF in group C were significantly lower than those in group A (P<0.05). but it was no significant difference between group B and group C (P>0.05). In addition, serum PLGF level in group B was significantly lower than that in group A (P<0.05), but hs-CRP level was not found obviously different between the two groups (P>0.05). There was no significant difference in the level of serum ox-LDL between three groups after3months treatment (P>0.05).7. During the follow up period, no side effects, such as hypersensitiveness, muscle haphalgesia, debilitation, and increasing of serum creatine kinase and hepatase. had been observed.Conclusion1. The investigation demonstrated that serum concentrations of hs-CRP, PLGF and ox-LDL in patients with ACS were significantly higher than those in controls, which suggested that the levels of hs-CRP, PLGF and ox-LDL could serve as powerful predictors of unstable atherosclerotic plaques and as indicators for risk stratification of the patients with ACS.2. Combined treatment by fluvastatin (40mg, QN) and probucol (250mg, Bid) or fluvastatin (80mg, QN) therapy had intensive effect on lowing serum lipid in ACS patiants. Especial])’, the combined theatment could further strengthen the efficacy, which indicated that combined treatment may have a synergistic effect in lowing the serum lipid.3. Combined treatment by fluvastatin (40mg, QN) and probucol (250mg, Bid) therapy had intensive effect on lowing serum hs-CRP, PLGF and ox-LDL in ACS patiants, which indicated that combined treatment may have stronger anti-inflammatory and anti-oxidative effects.4. Fluvastatin combined with probucol were safety and effective in the patients with ACS.5. The anti-inflammatory effect of fluvastatin was independent from lipids-regulating effect. |
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