心肌梗死患者血糖控制水平对他汀类药物调脂效果的影响  

Effect of Blood Glucose Levels on Lipid-lowering Therapy in Patients with Myocardial Infraction

作　　者：韩宝石[1] 杨庭树[1] 冯斌[1] 殷晓伟[2] 盖鲁粤[1] 

机构地区：[1]解放军总医院心血管内科,北京市100853 [2]解放军316医院内科,北京市100093

出　　处：《中国康复理论与实践》2008年第6期550-552,共3页Chinese Journal of Rehabilitation Theory and Practice

基　　金：军队“十五”科研基金重点资助项目(No01Z036)

摘　　要：目的研究心肌梗死患者血糖控制情况对调脂治疗效果的影响。方法将174例急性或陈旧性心肌梗死患者按是否合并糖尿病以及2年复查时血糖控制情况,分为糖尿病血糖控制良好组(DM+W组)、糖尿病血糖控制不佳组(DM+B组)、非糖尿病血糖控制良好组(NDM+W组)和非糖尿病血糖控制不佳组(NDM+B组),比较治疗前后及各组之间血脂水平、他汀类药物服药剂量和药物不良反应发生率。结果全部174例心肌梗死患者中合并糖尿病者51例(25.9%)。2年复查时DM+B组患者为13例(占糖尿病患者总数的25.5%),NDM+B组患者为24例(占非糖尿病患者总数的19.5%),这两组患者血浆总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-c)和低密度脂蛋白胆固醇(LDL-c)平均水平较入选时均无明显变化,LDL-c平均水平呈增高趋势。但即使DM+W组患者血浆LDL-c平均水平(2.57mmol/L)也未达到指南建议的<2.06mmol/L的标准。糖尿病与非糖尿病患者在他汀类服药方式上无明显差异,在2年复查时坚持按常规剂量服药者仅53.4%,采用较低剂量者占34.5%,未服药者占9.2%。合并糖尿病者长期服用他汀类药物未增加肝酶异常发生率。结论心肌梗死后血糖控制不佳使他汀类药物调脂治疗效果下降,合并糖尿病者他汀类药物服药剂量不足更为明显。Objective To investigate the effect of blood glucose levels on lipid-lowering therapy in patients with myocardial infraction （MI）. Methods The data of 174 patients with acute or old MI and finished a two-year follow-up were analyzed retrospectively. The patients were divided into four groups., diabetes mellitus （DM） with well blood glucose control （DM＋W group）, diabetes melli- tus with bad blood glucose control （DM＋B group）, non-diabetes mellitus with well blood glucose control （NDM＋ W group） and non-diabetes mellitus with bad blood glucose control （NDM＋B group）. Blood lipids levels, dose and side effects of statins were statistically analyzed. Results All the 174 patients had a mean follow-up period of 28 ± 7 months, and 51 patients （25.9%） had diabetes mellitus. In DM＋B group （n=13, 25.5%） and NDM＋B group （n=24, 19.5%）, there were no statistically difference between enrollment and 2-year follow-up in the mean levels of blood total cholesterol （TC）, triglycerides （TG）, high density lipoprotein cholesterol （HDL-c） and low density lipoprotein cholesterol （LDL-c）, but the mean level of LDL-c had a trend of elevation. In DM＋W group, the mean level of LDL-c was 2.57 mmol/L at 2-year follow-up, which did not achieve the recommended LDL-c goal （2.06 mmol/L）. There were no differences in statin therapy between each group. After 2-year follow-up, there were only 93 patients （53.4%） received normal dose of statin, 60 patients （34.5%） took low dose of statin and 16 patients （9.2%） had no statin therapy. There were no differences in hepatic enzyme abnormality between each group. Conclusion The bad control of blood glucose in patients with MI effect the efficacy of statins in lipid-lowering therapy. The doses of statin are insufficient especial in patients with MI and DM.

关 键 词：心肌梗死 二级预防 血糖 血脂 

分 类 号：R542.2[医药卫生—心血管疾病]