| Objective: Acute coronary syndromes (ACS) includes unstable angina pectoris, acute myocardial infarction and sudden death. Its mechanism includes plaque rupture, vasoconstriction and formation of thrombus. In recent years inflammation is demonstrated to be an important factor for the onset of ACS. The pathogenesis of inflammation is incompletely clear. The biological characteristics of the plaque are the main factor that determines its stability. The conventional therapeutic principles for ACS include reducing oxygen demand thrombosis revascularization antiplate therapy and anticoagulant therapy. The therapeutic principles proposed at present include improving endothelial function anti-inflammation and antibiotic therapy. The new principles are going to be explored. A variety of major long-term clinical trials of lowering lipid have raised us to our understanding the pathophysiology of coronary atherosclerosis and ischemia. It's evidenced that lipid lowering has potential anti-ischemic effects and may have a favorable impact on coronary events. Particularly statins reduce coronary events, modify endothelial dysfunction,stabilize plaque and promote coronary vasodilation. The benefits of lipid lowering in patients with acute coronary syndromes have been less well studied. Additional studies are needed to confirm the benefit of early statin treatment in patients with unstable coronary disease and to elucidate the reasons for the occurrence of events in the patients. The patients with ACS used simvastatin early were observed the variations of interleukin-6(IL-6), tumor necrosis factor- a (TNF- a )and nitric oxide(NO) levels and evaluated its effect of anti-inflammtion and improving endothelial function.Methods: 52 patients with ACS were enrolled (37 men ,15 women;age 42-77, average 61.65 + 9.68 years). The patients all correspond to the dianosis criteria of AMI and UAP in 1979(WHO). Their total choleserol 5.2mmol/L and LDL cholesterol 3.12mmol/L. The following disease were excluded :such as infectious disease tumor chronic obstructive pulmonary disease selfimmunized disease heart failure surgery the patient took lipid lowering agents the last 2 weeks the patient with hepatic or renal impairment. Subjects were randomized to simvastatin(26cases)or routine therapy(26cases)groups. Simvastatin group (14 men, 12 women; age 4576, average 63.05 + 9.09 years; 13 UAP or NQAMI, 13 QAMI, 8 thrombolysis), routine group(15 men,ll women; age 4277, average 60.3+10.0 years;14 UAP or NQAMI, 12QAMI, 7 thrombolysis). A age, sex ,smoke, hypertension, diabetes mellitus, heart rate, bloodpressure, serum lipid, CK peak value and drug uses between simvastatin and routine group were not significant differences. In addition, 30 healthy people were selected as a control (normal group) so that we could evaluate the effect of simvastatin on the patients with ACS. Both groups were all treated by routine therapy, on this basis,20 mg simvastatin were given simvastatin 20 mg once a day before sleep in simvastatin group, then IL-6 TNF- a and NO levels were measured before treatment and after 20 days respectively The levels of IL-6 and TNF- a were measured by radioimmunoassay, and the level of NO were measured by nitric acid reductase assay.Results: The changes of blood lipid in both groups: After therapy, blood lipid values were decreased in simvastatin group, but only TC and LDL cholesterol were decreased significantly. The levels of IL-6 and TNF- a in all of the patients were higher than those in normal group. The levels of NO is lower than normal group. In simvastatin group, the levels of IL-6 and TNF- a after therapy were decreased significantly than those before therapy(P<0.01), the levels of NO were increased than those before therapy. There were significant differences in the levels of the three parameters between simvastatin and normal group(P0.01). The values of IL-6 and NO were improved slightly in routine group than those before therapy, but it is not significant difference(P>0.05). There were a positive relationship... |
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