脑梗死危险分层下小剂量辛伐他汀达标预防再发对照研究  

Prevention on recurrence of low dosage simvastatin for targeting goal of cholesterol-lowering on risk stratification in patients with cerebral infarction

作　　者：王连芹 魏玉清 于强 宁海春 赵丽娟 孔咏梅 李国锋 

机构地区：[1]邢台市第三医院脑血管病治疗中心,河北邢台054000

出　　处：《临床荟萃》2009年第23期2053-2056,共4页Clinical Focus

基　　金：河北省2006年科学技术研究与发展指导计划项目(06276102D-16)

摘　　要：目的探讨脑梗死危险分层下小剂量辛伐他汀达标预防再发的效果、安全性及依从性的对照研究。方法初发性脑梗死患者287例,随机分为辛伐他汀组147例、阿托伐他汀组140例,给予辛伐他汀或阿托伐他汀10～20 mg每天晚饭后口服。两组均分为高危患者和极高危患者,脑梗死的高危患者以低密度脂蛋白胆固醇(LDL-C)<2.6 mmol/L为达标,极高危患者以LDL-C<2.1 mmol/L为达标,达标后5～10 mg长期维持。比较两组治疗前后LDL-C变化、不良反应、药费及退出情况。结果两组治疗1年后LDL-C水平均较治疗前明显下降,辛伐他汀组高危患者(3.58±0.81)mmol/Lvs(2.49±0.33)mmol/L、极高危患者(3.73±0.72)mmol/L vs(1.94±0.12)mmol/L,阿托伐他汀组高危患者(3.42±0.71)mmol/L vs(2.55±0.22)mmol/L、极高危患者(3.61±0.42)mmol/Lvs(1.95±0.21)mmol/L(均P<0.05);但两组间治疗前及1年后LDL-C水平比较无统计学意义(P>0.05)。两组第1、3、6、9及12个月LDL-C的达标率差异均无统计学意义(P>0.05)。两组均无脑梗死再发和其他血管事件的发生,也无死亡患者。两组不良反应差异无统计学意义(P>0.05);辛伐他汀组药费明显低于阿托伐他汀组(P<0.01);辛伐他汀组退出率明显低于阿托伐他汀组(P<0.01)。结论在脑梗死的危险分层下,应用小剂量辛伐他汀能使LDL-C持续达标,预防脑梗死再发效果理想、可靠安全、价格低廉,患者依从性好,能使广大患者获益。ABSTRACT： Objective To explore the effect, safety and compliance on low dosage of simvastatin for targeting goal of cholesterol-lowering on risk stratification with brain infarction. Methods Two hundred and eighty-seven subjects with brain infaction were enrolled and 147 cases were randomized in simvastatin group, 140 cases were randomized in storvastation group,a daily dose of 10--20 mg after evening. Two groups both further included high risk and very high risk patients groups. LDL-C level for the rate of high risk and the very high risk of cerebral infarction were （2.6 mmol/L, （2.1mmol/L, respectively, 5--10 mg statin dosage for targeting goal of LDL-C. The LDL C level, side effects, costs of drug and exit between two groups after treatment were compared with those before treatment. Results The LDL-C levels of two groups after 1 year＇s treatment compared with before treatment were decreased significantly（ P 〈0.05） ,the high risk of simvastatin （3.58±0.81） mmol/L vs （2.49±0.33） mmol/L,the very high risk （3.73±0.72） mmol/L vs （1.94±0.12） mmol/L,the high risk of atorvastatin （3.42±0.71） mmol/L vs （2.55±0.22） mmol/L,the very high risk （3.61±0.42） mmol/L vs （1.95±0.21） mmol/L（allP 〈0.05）.The levels of LDL-C between two groups were no statistical significance before treatment and after 1 year＇s treatment （ P 〉0.05）. The compliance rate between two groups of LDL-C in 1,3,6,9 and 12 months were no significant difference （P 〉 0.05）. The two groups had no recurrence of cerebral infarction and other vascular events, also no death. The adverse reactions between two groups were no statistical significance （ P 〉0.05）. The cost of simvastatin group was lower than that of atorvastatin group （ P 〈0.01）. The exit rate of simvastatin group was lower than that of atorvastatin group （P 〈 0.01）. Conclusion On risk stratification in patients with brain infarction,individual lowerdosage of simvastatin needs to keep the LDL-C targeting goal an

关 键 词：脑梗塞 辛伐他汀 个体化达标 安全性 病人依从 

分 类 号：R743.33[医药卫生—神经病学与精神病学]