目的 探討瑞舒伐他汀聯(lián)合氯吡格雷對(duì)不穩(wěn)定型心絞痛患者血管內(nèi)皮功能及尿酸、血脂水平的影響。方法 96例住院治療的不穩(wěn)定型心絞痛患者隨機(jī)分為觀察組（n=48）和對(duì)照組（n=48），對(duì)照組患者給予常規(guī)治療和晨服硫酸氫氯吡格雷75 mg，聯(lián)合組在對(duì)照組基礎(chǔ)上睡前口服瑞舒伐他汀鈣10 mg，均治療4周。治療后評(píng)估療效，記錄治療前后心絞痛發(fā)作頻率和持續(xù)時(shí)間，不良反應(yīng)發(fā)生情況，檢測(cè)兩組患者治療前后血清血管內(nèi)皮生長(zhǎng)因子（VEGF）、內(nèi)皮素-1（ET-1）、一氧化氮（NO）、尿酸（UA）和血脂水平。結(jié)果 觀察組患者治療后總有效率95.8%，高于對(duì)照組的83.3%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）；兩組患者治療后心絞痛發(fā)作頻率和持續(xù)時(shí)間均較治療前減少，且觀察組優(yōu)于對(duì)照組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。與治療前相比，對(duì)照組患者治療后血清VEGF和NO水平升高，而UA水平降低，觀察組的VEGF和NO水平均升高，而ET-1、UA、總膽固醇（TC）、三酰甘油（TG）和低密度脂蛋白膽固醇（LDL-C）水平均降低，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）；治療后觀察組血清VEGF和NO水平均升高，而ET-1、UA、TC、TG和LDL-C水平均降低，與對(duì)照組相比差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。兩組患者均未出現(xiàn)橫紋肌溶解，轉(zhuǎn)氨酶升高及消化道反應(yīng)發(fā)生率均無統(tǒng)計(jì)學(xué)意義。結(jié)論 瑞舒伐他汀聯(lián)合氯吡格雷可有效提高不穩(wěn)定型心絞痛患者臨床療效，改善血管內(nèi)皮功能、抑制炎性反應(yīng)、降低血脂水平，且不增加不良反應(yīng)的發(fā)生。

Objective To investigate the effects of rosuvastatin combined with clopidogrel on endothelial function and serum levels of uric acid and lipid in patients with unstable angina.Methods A total of 96 cases of hospitalized patients with unstable angina were randomly divided into combined group (n=48) and control group (n=48).Patients in the control group were given conventional therapy and morning service clopidogrel bisulfate 75 mg.Patients in the combined group were given orally rosuvastatin calcium 10 mg at bedtime.All patients in the two groups were treated for 4 weeks.After treatment,the clinical effect was evaluated;The seizure frequencies and durations before and after treatment and adverse drug reaction was recorded;VEGF,ET-1,NO,UA,TC,TG,LDLC,and HDL-C levels of two groups were detected.Results The total efficiency rate after treatment in the combined group was 95.8%,which was higher than 83.3%,the difference was statistically significant (P<0.05).Compared with the before treatment,the seizure frequencies and durations after treatment in the two groups were reduced,the seizure frequencies and durations after treatment in the combined group were less than the control group,the differences were statistically significant (P<0.05).Compared with before treatment,the serum levels of VEGF and NO after treatment in the control group were increased,while levels of UA were decreased,the serum levels of VEGF and NO after treatment in the combined group were increased,while the levels of ET-1,UA,TC,TG and LDL-C were decreased,the differences were statistically significant (P< 0.05).Compared with the control group,the serum levels of VEGF and NO after treatment in the combined group were increased,while the levels of ET-1,UA,TC,TG and LDL-C were decreased,the differences were statistically significant (P< 0.05).The rhabdomyolysis were not appearing in the two groups.The differences of the reaction rates of elevated transaminases and gastrointestinal reaction between the two groups were no significant.Conclusion Rosuvastatin combined with clopidogrel could effectively improve the clinical efficacy in patients with unstable angina,improve endothelial function,inhibit inflammation,reduce blood lipid levels,and without increasing the incidence of adverse reactions.

山東省自然科學(xué)基金（ZR2015HL130）