目的 探討低分子肝素聯(lián)合辛伐他汀治療急性冠脈綜合征的臨床療效。方法 選取2011年1月—2014年1月攀鋼集團(tuán)總醫(yī)院收治的急性冠狀動(dòng)脈綜合征患者120例, 隨機(jī)分為低分子肝素組、辛伐他汀組和聯(lián)合治療組, 每組40例。低分子肝素組患者在常規(guī)治療的基礎(chǔ)上sc低分子肝素鈣注射液, 80 U/kg, 2次/d。辛伐他汀組患者在常規(guī)治療的基礎(chǔ)上po辛伐他汀片, 4片/次, 1次/d。聯(lián)合治療組患者在常規(guī)治療的基礎(chǔ)上加用低分子肝素鈣和辛伐他汀片, 用法用量同以上兩組。3組患者均連續(xù)治療6周。治療后, 對(duì)3組患者的癥狀療效和心電圖療效進(jìn)行評(píng)價(jià), 同時(shí)比較3組治療前后血脂指標(biāo)和高敏C反應(yīng)蛋白(hs-CRP)的水平變化。結(jié)果 治療后, 低分子肝素組、辛伐他汀組、聯(lián)合治療組癥狀療效總有效率分別為60.0%、67.5%、87.5%, 聯(lián)合治療組的總有效率顯著高于低分子肝素組和辛伐他汀組, 差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。3組心電圖療效總有效率分別為62.5%、67.5%、92.5%, 聯(lián)合治療組的總有效率顯著高于低分子肝素組和辛伐他汀組, 差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)。治療后, 辛伐他汀組和聯(lián)合治療組患者總膽固醇(TC)、三酰甘油(TG)和低密度脂蛋白膽固醇(LDL-C)均較治療前降低, 高密度脂蛋白膽固醇(HDL-C)水平升高, 但同組治療前后差異無(wú)統(tǒng)計(jì)學(xué)意義。3組hs-CRP水平均較治療前顯著降低, 同組治療前后差異有統(tǒng)計(jì)學(xué)意義(P<0.01);治療后, 聯(lián)合治療組低于以上兩組, 差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 低分子肝素聯(lián)合辛伐他汀治療急性冠脈綜合征具有較好的臨床療效, 可顯著降低患者h(yuǎn)s-CRP水平, 優(yōu)于兩藥單獨(dú)應(yīng)用。

Objective To investigate the efficacy of low molecular heparin combined with simvastatin in treatment of acute coronary syndrome. Methods Patients (120 cases) with acute coronary syndrome who came to the General Hospital of Panzhihua Iron and Steel Group from January 2011 to January 2014 were randomly divided into low molecular heparin, simvastatin and combined treatment groups, and each group had 40 cases. Patients in the low molecular heparin group were sc administered with Low Molecular Heparin Calcium Injection on the basis of conventional treatment, 80 U/kg, twice daily. Patients in the simvastatin group were po administered with Simvastatin Tablets on the basis of conventional treatment, 4 tablets/time, once daily. Patients in the combined treatment group were given Low Molecular Heparin Calcium Injection and Simvastatin Tablets, and the usage and dosage was the same to the above two groups. Three groups were continuously treated for 6 weeks. After treatment, the symptom efficacy and electrocardiogram efficacy in three groups were evaluated, while the changes of lipid indexes and hs-CRP before and after treatment were compared. Results After treatment, the symptom efficacies on the patients in the low molecular heparin, simvastatin and combined treatment groups were 60.0%, 67.5% and 87.5%, and the symptom efficacy in the combined treatment group was higher than those in the other two groups with the significant difference (P < 0.05). The electrocardiogram efficacies in three groups were 62.5%, 67.5%, and 92.5%, and the electrocardiogram efficacy in the combined treatment group was higher than those in the other two groups with the significant difference (P < 0.05). After treatment, TC, TG, and LDL-C in simvastatin and combined treatment group was reduced, HDL-C was elevated, but there was no statistically significant difference before and after treatment. The levels of hs-CRP in three groups were significantly reduced, and the differences were statistically significant before and after treatment in the same group (P < 0.01). After treatment, hs-CRP of combined the treatment group was lower than the above two groups, and the difference was statistically significant (P < 0.05). Conclusion Low molecular heparin combined with simvastatin has a good clinical efficacy in treatment of acute coronary syndrome, and can significantly reduce hs-CRP level, which is better than that of each drug used alone.