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目的:探讨罗格列酮、洛伐他汀早期对不稳定型心绞痛(UA)患者肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平的影响。方法:94例UA患者随机分为5组,A组18例常规治疗,B组19例加用罗格列酮4mg.d-1,C组18例加用罗格列酮8mg.d-1,D组20例加用洛伐他汀20mg.d-1,E组19例加用洛伐他汀40mg.d-1;稳定型心绞痛(SA)患者20例为对照组。各组在治疗1周前、后均测定血清TNF-α、IL-6及血脂水平。结果:UA患者TNF-α、IL-6水平明显高于SA(P<0.05);罗格列酮治疗后TNF-α、IL-6水平无明显改变(P>0.05);洛伐他汀治疗后TNF-α、IL-6水平有明显下降(P<0.05),以40mg.d-1组作用更明显;TNF-α、IL-6与血脂水平不相关(P>0.05)。结论:UA患者血清炎症因子水平增高,早期洛伐他汀治疗可降低UA患者TNF-α和IL-6水平。其抗炎作用独立于降脂作用之外,早期他汀类药物强化治疗能使UA患者获益更大。但罗格列酮在早期治疗中未见明显抗炎作用,可能需长期治疗才能得益。
Objective: To investigate the effects of rosiglitazone and lovastatin on the levels of tumor necrosis factor α (TNF-α) and interleukin-6 (IL-6) in patients with unstable angina pectoris (UA). Methods: Ninety-four patients with UA were randomly divided into five groups: 18 patients in group A received routine treatment, 19 patients in group B received rosiglitazone 4 mg.d-1, 18 patients in group C received rosiglitazone 8 mg.d-1 , 20 patients in group D received lovastatin 20 mg.d-1, 19 patients in group E received lovastatin 40 mg.d-1, and 20 patients in stable angina pectoris (SA) served as control group. Serum levels of TNF-α, IL-6 and blood lipid in each group before and after treatment for 1 week were measured. Results: The levels of TNF-α and IL-6 in patients with UA were significantly higher than those in patients with SA (P <0.05). No significant changes were found in the levels of TNF-α and IL-6 after rosiglitazone treatment The levels of TNF-α and IL-6 were significantly decreased (P <0.05), and the effects of 40 mg · d-1 were more significant. The levels of TNF-α and IL-6 were not correlated with the level of serum lipids (P> 0.05). CONCLUSIONS: Serum levels of inflammatory cytokines are elevated in patients with UA, and early lovastatin treatment may reduce the levels of TNF-α and IL-6 in UA patients. Its anti-inflammatory effects are independent of lipid-lowering effects, and early statin intensive treatment can benefit UA patients even more. However, no obvious anti-inflammatory effect of rosiglitazone in the early treatment, may need long-term treatment to benefit.