| Objective: Acute coronary syndrome(ACS)is a severe and acute clinical event in coronary heart disease(CHD).The major pathogenesis of the majority ACS is the coronary artery thrombosis lead by unstable plaque rupture or erosion of the atherosclerosis.The abroad research indicates that oxidized low-density lipoprote(oxLDL)closely relates to the development of ACS which is the independently associated factor on severity of coronary artery disease.Compare with the low density lipoprotein cholesterol(LDL-C),oxLDL could better reflect the stable state of the coronary atherosclerotic plaque.Due to the limition of the pro-detection method,oxLDL has not become the conventional detection method of the CAD in the past.Even though the detection method of oxLDL proceses mature currently,its clinical significance for CAD has not been widely recognized.Statins have both LDL-lowering properties and pleiotropic.As a lipid oxidation marker,however there is a paucity of data regarding the effects of oxLDL in patients after statin use.The purpose of this present study was to prospectively observed that the clinical significance of the serum ox LDL for CHD at the different state,and evaluate the impact the effects of different dose of atorvastatin on oxLDL in ACS patients.Methods:Take the diagnosis of acute coronary syndrome and stable angina(SA)which customized by the CMA as the standard to choose 138 patients who had performed coronary angiography(CAG)in the department of cardiology,the Second Hospital of Hebei Medical University during 2015.1 to 2015.12.Among of that 105 patients were diagnosed as ACS,33 SAP patients.Above all the patients test the serum oxLDL level within the 24 hours after admission to the hospital.The ACS patients were further subdivided into three groups randomly to low-dose group(atorvastatin 20mg/d)?middle-dose(atorvastatin 40mg/d)and high-dose group(atorvastatin 80mg/d),35 patients in each group.Blood samples were collected three groups before and 4 weeks after the dosing including oxLDL?LDL-C?Alanine aminotransferase(ALT)?Creatine kinase(CK),Compared with the baseline levels of serum oxLDL between the ACS group and the SA group.Compared with the level of serum oxLDL ?LDL-C?ALT?CK and the LDL-C target rates before and 4 weeks after among the low-dose group?middle-dose and high-dose group.The Statistical Package for the Social Sciences(SPSS)21.0 software was used for statistical analysis,and the level of statistical significance was set at P<0.05.The main statistical indicators were tested for normality and equality of variance test.The results of measurement data are expressed as mean±SD values.Comparison of the multiple samples that meet homogeneity of variance test will be analyzed by analysis of variance,if the difference was statistically significant the datd will be analyed by SNK-q test.Comparison of the multiple samples that can not meet homogeneity of variance test will be analyzed by Kruskal-wallis H test,if the difference was statistically significant the data will be analyzed by Nemenyi test.Linear correlation will be used for Correlation analysis.Result:1 Comparison of the general clinical data of each group patients: The baseline character of the two groups(ACS group and SA group)had no statistically difference(P>0.05).The baseline character of the three groups(low-dose group,middle-dose group,high-dose group)had no statistically difference(P>0.05);2 Comparison of the serum oxLDL between ACS group and SA group: The serum oxLDL level of the ACS group was higher than the SA patients and had the statistically significant difference(60.26 ± 27.97 vs.23.46±10.56,P<0.001);3 Comparison of the serum oxLDL in ACS patients among the low-dose,middle-dose,high-dose three groups before and after the treatment:The serum oxLDL level of the low-dose,middle-dose,high-dose three groups after the treatment(36.75 ± 18.04,32.81 ± 17.36,21.63 ± 9.70)was significantly lower than the index before treatment(58.61 ± 30.98,54.50 ± 27.71,67.67 ± 23.90),and there was statistically significance difference(P<0.001).The different value of the serum oxLDL(M=19.20,QR=24.36?M=20.77,QR=23.29 ? 46.04±22.76)among the low-dose,middle-dose,high-dose three groups before and after treatment had the significantly different.The descend range of the high-dose group was higher than the low-dose and middle-dose group,and it has the statistically significant difference(P<0.001);The descend range of low-dose group and middle-dose group was no statistically difference(P> 0.05);4 Comparison of the plasma LDL-C of the ACS patients among the low-dose,middle-dose,high-dose three groups before and after the treatment:The plasma LDL-C among the low-dose,middle-dose,high-dose three groups after treatment(2.37±0.47 ? 2.21±0.46 ? 1.96±0.48)was significantly lower than that the index before treatment(2.85±0.61 ?2.80±0.67 ? 3.06±0.61),and the difference has statistically significance(P<0.001).The comparison of the difference(0.48±0.40 ? 0.59±0.37 ?1.10±0.62)on plasma LDL-C among the low-dose,middle-dose,high-dose three groups before and after the treatment had the statistically significance.The descend range of the high-dose group was higher than low-dose and middle-dose group and had the statistically significant difference(P<0.05);The descend range compared between low-dose group and middle-dose group has no statistically difference(P<0.05);5 Comparison of the target rates of the plasma LDL-C in ACS patients among the low-dose,middle-dose,high-dose three groups before and after treatment:No statistically significance difference among three groups before treatment,after 4 weeks treatment the control rate of high-dose group was higher than low-dose group(42.9%vs.11.4%,P=0.003),there was no difference between middle-dose group and low-dose group(22.9%vs.11.4%,P>0.05);6 Correlation analysis of the plasma oxLDL and LDL-C: The relativity of the plasma LDL-C and oxLDL in ACS patients was not obvious(r = 0.170,P>0.05);7 The safety assessment of the different doses in the ACS patients among three groups after the treatment: There was no statistically difference(P=0.065)before and after treatment on ALT level among the patients of the three groups;there was the statistically difference(P=0.015)on the CK levels among the three groups patients before and after the treatment.No case of adverse events was observed in low-dose group.Only one patient from middle-dose group complained of myalgia,but no abnormal on CK.Two of the patients from high-dose group had the gastrointestinal discomfort and liver enzymes elevation ? 3 times of ULN,the symptoms disappeared 1-2 weeks after discontinuation of drug and the liver enzymes returned to normal.One case on myalgia but the CK were normal.Conclusion:1 The plasma oxLDL levels of the patient with CHD was higher than non-CHD group,among of that the oxLDL of the ACS patients was higher than the patients with SA group.2 Compared with the low-dose and middle-dose groups,high-dose group reduced oxLDL more significant and the antioxidant effects stronger. |
PDF Full Text Request