Miedema Michael D, Conover Cheryl A, MacDonald Holly, Harrington Sean C, Oberg Dedra, Wilson Daniel, Henry Timothy D, Schwartz Robert S
Minneapolis Heart Institute and Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Am J Cardiol. 2008 Jan 1;101(1):35-9. doi: 10.1016/j.amjcard.2007.07.045.
Pregnancy-associated plasma protein-A (PAPP-A) was associated with atherosclerotic plaque vulnerability, whereas statin therapy was associated with increased plaque stability. Eighty-six patients presenting with clinical indications (non-ST-elevation myocardial infarction, unstable angina, and stable angina) for invasive coronary angiography and subsequent verified coronary artery disease (CAD) were randomly assigned in a double-blind manner to atorvastatin 10 or 80 mg/day. PAPP-A, high-sensitivity C-reactive protein (hs-CRP), and lipids were measured at baseline (before statin therapy) and at 1 and 6 months. PAPP-A was significantly increased in 35 patients with acute coronary syndrome (ACS) compared with 51 patients with stable CAD (p <0.001). Patients randomly assigned to atorvastatin 10 mg did not show a significant decrease in PAPP-A from baseline at 1 or 6 months. Patients treated with atorvastatin 80 mg showed a significant decrease at 1 month compared with baseline, but not at 6 months. hs-CRP was not significantly different between the ACS and stable CAD groups. Patients receiving atorvastatin 10 mg showed no hs-CRP decrease at 1 or 6 months, whereas it significantly decreased in the 80-mg group at 6 months, but not at 1 month. In conclusion, PAPP-A significantly increased in patients with ACS compared with those with stable coronary disease. High-dose atorvastatin significantly decreased PAPP-A at 1 month and hs-CRP at 6 months in patients with verified CAD. Low-dose atorvastatin did not produce this effect.
妊娠相关血浆蛋白-A（PAPP-A）与动脉粥样硬化斑块易损性相关，而他汀类药物治疗与斑块稳定性增加相关。86例因有创冠状动脉造影及随后确诊为冠心病（CAD）的临床指征（非ST段抬高型心肌梗死、不稳定型心绞痛和稳定型心绞痛）而就诊的患者，以双盲方式随机分配至阿托伐他汀10mg/天或80mg/天治疗组。在基线（他汀类药物治疗前）、1个月和6个月时测量PAPP-A、高敏C反应蛋白（hs-CRP）和血脂。与51例稳定型CAD患者相比，35例急性冠状动脉综合征（ACS）患者的PAPP-A显著升高（p<0.001）。随机分配至阿托伐他汀10mg组的患者在1个月或6个月时PAPP-A较基线未显著降低。接受阿托伐他汀80mg治疗的患者在1个月时较基线显著降低，但在6个月时未降低。ACS组和稳定型CAD组之间hs-CRP无显著差异。接受阿托伐他汀10mg治疗的患者在1个月或6个月时hs-CRP未降低，而80mg组在6个月时显著降低，但在1个月时未降低。总之，与稳定型冠心病患者相比，ACS患者的PAPP-A显著升高。高剂量阿托伐他汀可使确诊为CAD的患者在1个月时PAPP-A显著降低，在6个月时hs-CRP显著降低。低剂量阿托伐他汀未产生此效果。
