目的 探讨瑞舒伐他汀联合氯吡格雷对不稳定型心绞痛患者血管内皮功能及尿酸、血脂水平的影响。方法 96例住院治疗的不稳定型心绞痛患者随机分为观察组（n=48）和对照组（n=48），对照组患者给予常规治疗和晨服硫酸氢氯吡格雷75 mg，联合组在对照组基础上睡前口服瑞舒伐他汀钙10 mg，均治疗4周。治疗后评估疗效，记录治疗前后心绞痛发作频率和持续时间，不良反应发生情况，检测两组患者治疗前后血清血管内皮生长因子（VEGF）、内皮素-1（ET-1）、一氧化氮（NO）、尿酸（UA）和血脂水平。结果 观察组患者治疗后总有效率95.8%，高于对照组的83.3%，差异有统计学意义（P<0.05）；两组患者治疗后心绞痛发作频率和持续时间均较治疗前减少，且观察组优于对照组，差异均有统计学意义（P<0.05）。与治疗前相比，对照组患者治疗后血清VEGF和NO水平升高，而UA水平降低，观察组的VEGF和NO水平均升高，而ET-1、UA、总胆固醇（TC）、三酰甘油（TG）和低密度脂蛋白胆固醇（LDL-C）水平均降低，差异均有统计学意义（P<0.05）；治疗后观察组血清VEGF和NO水平均升高，而ET-1、UA、TC、TG和LDL-C水平均降低，与对照组相比差异均有统计学意义（P<0.05）。两组患者均未出现横纹肌溶解，转氨酶升高及消化道反应发生率均无统计学意义。结论 瑞舒伐他汀联合氯吡格雷可有效提高不稳定型心绞痛患者临床疗效，改善血管内皮功能、抑制炎性反应、降低血脂水平，且不增加不良反应的发生。

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.

山东省自然科学基金（ZR2015HL130）