调脂治疗对冠心病病人血脂和心肌缺血影响的研究  

Effect of Lipid Modulating Treatment on the Lipids Level and Myocardial Ischemia in Patients with Coronary Artery Disease

作　　者：李景东[1,2] 戴闺柱[1,2] 杨正武 吴剑萍[1,2] 饶利亚 周本财 

机构地区：[1]同济医科大学心血管病研究所 [2]湖北省公安县第二人民医院

出　　处：《现代康复》1998年第9期926-927,共2页Modern Rehabilitation

摘　　要：目的：探讨调脂治疗在冠心病二级预防中，能否通过纠正血脂异常而发挥抗心肌缺血的有益作用和改善临床症状。方法：选择２２例冠心病合并高三酰甘油（ＴＧ）、低高密度脂蛋白－胆固醇（ＨＤＬ－Ｃ）血症病人应用非诺贝特治疗一月后，观察其治疗前后血脂和部分病人缺血总负荷的变化以及临床症状是否改善，缺血总负荷的变化指２４小时内动态心电图发作性ＳＴ段水平型或下斜性压低≥１ｍｍ相加的总时间。结果：经非诺贝特治疗一月后，血ＴＧ水平明显下降（分别为３．１４±０．９５ｍｍｏｌ／Ｌ和１．１６±０．４０ｍｍｏｌ／Ｌ，Ｐ＜０．０１）。血胆固醇（ＴＣ）水平也明显下降（分别为６．０６±０．５２ｍｍｏｌ／Ｌ和５．３８±０．２８ｍｍｏｌ／Ｌ，Ｐ＜０．０５）；调脂治疗前后血ＨＤＬ－Ｃ、ＨＤＬ２－Ｃ和ＨＤＬ３－Ｃ则分别为０．８５±０．１４、０．２６±０．１６、０．６７±０．１７ｍｍｏｌ／Ｌ和１．１５±０．２８、０．３９±０．１５、０．７５±０．１８ｍｍｏｌ／Ｌ，三项指标治疗前后均有显著性差异（均Ｐ＜０．０５）。７例缺血总负荷的变化为：３例发作性ＳＴ段下移者均有降低，４例呈固定性ＳＴ段下移者则无明显改变。１１例病人硝酸酯类制剂用量和胸痛发作减少。结论：调脂?Objective:To investigate whether the lipid Modulating treatment can improve myocardial ischemia and clinical symptoms by changing lipids level in patients with coronary artery disease(CAD).Methods:Twenty-two CAD patients with low high density lipoprotein (HDL)and hypertriglyceridemia were enrolled.All CAD patients were given fenofibrate 300mg daily for one month.Lipids level,total ischemia burden and clinical symptoms were observed before and after the treatment.The total time of paroxysmal horizontal or downward sloping ST-segment depression of 0.1 mv or more was used as the index of total ischemia burden(TIB).Results:One month after fenofibrate treatment,triglycerides(TG)level significantly decreased from 3.14±0.95 to 1.16±0.40mmol/L(P<0.01),total cholesterol(TC)from 6.06±0.52 to 5.38±1.14(P<0.05),while HDL-C increased from 0.85±0.14 to 1.15±0.28(P<0.05),HDL2-C from 0.26±0.16 to 0.39±0.15(P<0.05),HDL3-C from 0.67±0.17 to 0.75±0.18(P<0.05).At the mean time,in 7 CAD patients,3 cases with exerciseinduced ST-segment depression had a reduced TIB and no difference was found in 4 cases with stable ST-segment depression.Also,11 patients needed less amounts of nitrate drugs and had fewer episodes of chest distress and chest pain.Conclusion:Lipid modulating treatment with fenofibrate produces a significant improvement in serium lipid levels in CAD patients ,which may be profitable in the prevention of myocardial ischemia and alleviation of symptoms.

关 键 词：调脂药 药物治疗 冠心病 血脂 心肌缺血 非诺贝特 

分 类 号：R541.4[医药卫生—心血管疾病] R542.2[医药卫生—内科学]