长春西汀对老年冠心病患者QT离散度和血浆IL-6、hs-CRP的影响

The Influence of The Injectable Vinpocetine on Levels of Plasma QT dispersion and hs-CRP and IL-6 in Elderly Patients With CoronaryHeart DiseaseA Dissertation Submitted toShihezi UniversityIn Partial F ul fillment of the Requirementsfor the Degree ofMaster of MedicineByGuo Zhe ng-lia ng( internal medicine)Dissertation Supervisor:Prof. Hua ng Ga ngmarch,2013石河子大学学位论文独创性声明及使用授权声明学位论文独创性声明本人所呈交的学位论文是在我导师的指导下进行的研究工作及取得的研究成果。

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研究生签名：时间：年月日导师签名：时间：年月日目录中文摘要 (Ⅰ)英文摘要 (Ⅱ)英文缩略词 (Ⅲ)前言 (1)材料和方法 (4)1研究对象 (4)2主要实验仪器 (4)3试剂与方法 (5)4 统计分析方法 (9)结果 (10)1.一般资料 (10)2.临床疗效比较 (10)3 三组血浆IL-6、hs-CRP含量比较 (11)4 hs-CRP与IL-6的相关性 (11)5.三组QTd及QTcd的比较 (13)讨论 (15)一、一般资料分析 (15)二、炎症反应与冠心病发病机制 (15)三、C反应蛋白与冠心病 (16)四、白细胞介素-6与冠心病 (17)五、CRP与IL-6的相关性 (18)六、QT离散度（QT dispersion，QTd）与冠心病 (18)结论 (21)参考文献 (22)综述 (23)致谢 (30)作者简介 (31)导师评阅表 (32)摘要目的观察注射用长春西汀对老年冠心病患者QT离散度（QTd）及血浆高敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)的影响。

方法150例老年冠心病患者随机分为对照组50例，给予常规药物治疗；30mg治疗组50例，在常规药物治疗的基础上运用30mg长春西汀；50mg治疗组50例，在常规药物治疗的基础上运用50mg长春西汀。

9天为一疗程。

结果①30mg治疗组及50mg治疗组有效率分别与对照组比较，有效率具有显著性差异，P均<O.05。

②治疗前三组hs-CRP分别为（4.70±0.68） mg/ml (对照组)，（4.76±0.86）mg／ml (30mg治疗组)，（4.82±0.94）mg/ml (50mg治疗组)；治疗后分别依次为（4.42±0.59）mg/m1，（4.18±0.93）mg/ml，（4.12±0.96）mg/ml。

治疗前三组IL-6分别为（6.41±0.90）pg/ml，（6.52±0.98）pg/ml，（6.48±1.30）pg/ml；治疗后依次分别为（5.89±0.87）pg/ml，（4.89±0.77）pg/ml，（3.57±0.84）pg/ml。

治疗前三组间hs-CRP、IL-6两两比较及治疗组（30mg治疗组+50mg治疗组）与对照组比较，无显著性差异。

治疗后三组间hs-CRP两两比较无显著性差异，但是，治疗组（30mg治疗组+50mg 治疗组）与对照组比较，有显著性差异，P<O.05。

治疗后IL-6比较： 30mg治疗组显著低于对照组，P<O.05；显著高于50mg治疗组，P<O.05，且对照组极显著高于50mg治疗组，P<O.01。

③血清hs-CRP水平与IL-6水平呈正相关(r=0.173，P=0.035)。

④对照组、30mg 治疗组、50mg治疗组三组治疗前QT离散度及校正后的QT离散度比较未见显著性差异，P ＞0.05；三组治疗后两两比较，30mg治疗组、50mg治疗组QT离散度及校正后的QT离散度均较对照组缩短，有显著性差异，P<O.05。

结论长春西汀对治疗老年冠心病有效；长春西汀能显著降低老年冠心病患者血浆hs-CRP及IL-6，且剂量不同降低IL-6的效果不同；长春西汀能够缩短老年冠心病患者的QT离散度，降低恶性心律失常发生的可能。

关键词：老年冠心病；高敏C反应蛋白；白细胞介素-6；QT离散度Abstractobjective To investigate the influence of the injectable vinpocetine to plasma inflammatory factor QT dispersion、high sensitivity C reactive protein (hs-CRP) and interleukina 6 (IL-6) in elderly patients with coronary heart disease (CHD). Methods 150 cases elderly coronary heart disease patients were randomly divided into control group (fifty cases)、treatment group 30 mg (fifty cases) and 50 mg (fifty cases).The control group was given conventional western medicine treatment; The treatment group was given the injectable vinpocetine (divided into 30 mg group and 50 mg group) on the basis of the conventional western medicine treatment , 1 time/day. Three groups were treated 9 days for one period. Results (1) 30 mg treatment group and 50 mg treatment group were effective significant difference respectively compared with control group, P<0.05.(2) high sensitivity C reactive protein in three groups before treatment was respectively 4.70±0.68mg/ml (control group), 4.76±0.86mg/ml (30mg treatment group), 4.82±0.94mg/ml(50mg treatment group); after treatment it was respectively 4.42±0.59mg/m1, 4.18±0.93mg/ml, 4.12±0.96mg/ml ]. Interleukin 6 in three groups before treatment was respectively 6.41±0.90pg/ml , 6.52±0.98 pg/ml， 6.48±1.30pg/ml; after treatment it was respectively 5.89±0.87pg/ml，4.89±0.77pg/ml，3.57±0.84pg/ml. Hs-CRP, IL-6 Before treatment in comparison of the three groups and between treatment group (30 mg group+50 mg group)and control group were no significantly difference. after treatment , the comparison between the three groups were no significantly difference, then treatment group (30 mg group+50 mg group) were significantly difference than the control group, P<0.05, After treatment ,IL–6 : 30mg treatment group was lowly significantly difference than the control group, P<0.05; highly significantly difference than 50 mg treatment group, P<0.05, moreover , the control group was highly significantly difference than 50 mg treatment group, P<0.01. (3) plasma inflammatory factor- high sensitivity C reactive protein (hs-CRP) and interleukina 6 (IL-6) were positively correlated(r=0.173，P=0.035).（4）QT dispersion before and after correction in comparison of the three groups(Control group, 30 mg treatment group, 50 mg treatment group) before treatment was no significantly difference, P > 0.05; comparing between the three groups after treatment, QT dispersion before and after correction in 30 mg and 50 mg treatment group was lowly significantly difference than control group,P<0.05. Conclusion Vinpocetine was effective for the treatment of coronary heart disease，The injectable vinpocetine can obviously reduce plasma inflammatory factor -high sensitivity C reactive protein (hs - CRP) and interleukina 6 (IL - 6) in elderly patients with coronary heart disease CHD) , and different dose has different effect in reducing interleukina 6 (IL-6); Vinpocetine can shorten QT dispersion in elderly patients with coronary heart disease CHD), reduce the malignant arrhythmia occurring.Keywords: elderly coronary heart disease; Interleukin 6 ; high sensitivity C- reactive protein；QT dispersion英文缩略词（Abbreviations）英文缩写英文全名中文译名hs-CRP High sensitivity C-reactive protein 高敏C反应蛋白IL-6 Interleukin-6 白细胞介素-6AS Atherosclerosis 动脉粥样硬化QTd QT dispersion QT离散度MCP - 1 Monocyte chemoattractant protein-1 单核细胞趋化蛋白-1 VCAM- 1 Vascular cell adhesion molecule-1血管细胞粘附分子-1BMI Body mass index 体重指数SBP Systolic blood pressure 收缩压DBP Diastolic blood pressure 舒张压F PG Fasting plasma glucose 空腹血糖TC Total cholesterol 总胆固醇TG Triglycerides甘油三酯LDL-C Low-density lipoprotein cholesterol 低密度脂蛋白胆固醇HDL High-density lipoprotein高密度脂蛋白前言（Introduction）流行病学研究认为到2020年为止，冠心病和脑卒中将分别是全球范围内第一位和第二位的死亡原因[1]，心脑血管病死亡率在发达国家中早已呈下降趋势，虽然我国心脑血管病的死亡率同发达国家一样，占全因死亡率的比率最高，但是我国心脑血管疾病死亡率仍然呈上升趋势[1-4]。