التأثيرات القلبية، المعدية، وحول الأنفية لمثبطات كلوبيدوغريل و HMG-CoA منفردة أو مع أدوية أخرى: دراسة بالموجات فوق الصوتية وتخطيط صدى القلب

د. نشوان صالح محمد الأشول

طبيب عام|| مستشفى النصر العام|| عيادة الأشول للأمراض الطبية والقلبية|| مدينة الضالع|| الجمهورية اليمنية

E-mail: nashwansaleh49@gmail.com || Orcid: https://orcid.org/0009-0001-1470-0943 || Mobile: 00967771601519

هدفت الدراسة إلى فحص المطاوعة المحورية الطولية لجدران القلب كافة وتقييم وظيفة البطين الأيسر وتشوهات الشرايين التاجية واضطرابات تدفق الدم، إضافة     إلى تحليل مؤشرات مرض H. pylori في المعدة والجيوب الأنفية. شملت العينة 1113 مريضًا من الجنسين، تم تقييمهم بتخطيط صدى القلب (الوضعان B وM والدوبلر اللوني) للقلب والشرايين التاجية، وفحص الموجات فوق الصوتية للمعدة والجيوب الأنفية، خلال الفترة من يناير 2022 إلى ديسمبر 2023 مع مراعاة تأثير متحورات SARS-CoV-2. تضمنت العلاجات: كلوبيدوغريل 150 ملغ، الستاتين 10 ملغ، الأسبرين 75 ملغ، جينكوبيلوبا 80 ملغ، رومالايا فورت، وكلاريثروميسين 250 ملغ. أظهرت النتائج انخفاضًا في مقاييس المطاوعة المحورية لدى جميع المرضى، مع وظيفة بطين أيسر طبيعية (EF 65–78%) لدى 95% وضعيفة (EF 25–40%) لدى 5%. وبرزت تشوهات الشرايين التاجية على هيئة عقد خرزية وتضيقات، إضافة إلى خيوط نسيجية معدية مرتبطة بالتهاب الجرثومة الحلزونية. أدى العلاج المشترك بجرعات مرتفعة من كلوبيدوغريل ومنخفضة من الستاتين وكلاريثروميسين إلى تحسين المطاوعة المحورية ووظيفة البطين الأيسر وخفض ضغط الدم وتقليل كثافة الخيوط النسيجية خلال 30 دقيقة. خلصت الدراسة إلى تحسن مناطق التضيق التاجي بنسبة 20–30% في اليوم الأول، وإثبات فعالية تخطيط الصدى والدوبلر كوسيلتين مبكرتين للتشخيص والمتابعة، إضافة إلى دور الكلاريثروميسين في تنظيم الوظائف القلبية والوعائية وخفض تأثيرات الجرثومة الحلزونية والالتهابات المصاحبة لمتحورات SARS-CoV-2. وتؤكد النتائج الترابط الحيوي بين صحة المعدة وسلامة القلب استجابةً لتأثيرات الأدوية والأغذية وتغيرات الفيروسات.           

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