不同调脂治疗方案对冠心病患者血脂和IL-6、TNF-α水平的影响  

Influence of different lipid-lowering treatments on serum lipids,IL-6 and TNF-α in patients with coronary heart disease

作　　者：梁伟[1] 杨晖 吴春芳[3] 余强 张大东 焦洁茹[1] 陆国平[3] 

机构地区：[1]上海交通大学医学院附属瑞金医院老年病科,上海200025 [2]上海闵行区中心医院心内科,上海201100 [3]上海交通大学医学院附属瑞金医院心内科,上海200025

出　　处：《检验医学》2011年第3期193-197,共5页Laboratory Medicine

摘　　要：目的比较冠心病患者单用阿托伐他汀(40 mg/d)及阿托伐他汀(10 mg/d)和依折麦布(10 mg/d)联合治疗的调脂作用及安全性,并探讨其对白细胞介素-6(IL-6)和肿瘤坏死因子α(TNF-α)的影响。方法选取冠状动脉狭窄50%～70%的冠心病患者42例,均不植入支架,分为阿托伐他汀组(19例)和阿托伐他汀+依折麦布组(23例)。在服药前、用药4周、用药12周时分别测定总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、肝功能、肾功能、肌酸激酶(CK)、IL-6和TNF-α水平。结果 2组均在用药后4周就可以明显降低患者的TC和LDL-C。12周时阿托伐他汀组的LDL-C为(1.94±0.49)mmol/L,较用药前下降37.82%,阿托伐他汀+依折麦布组的LDL-C为(1.92±0.54)mmol/L,下降38.26%,2组之间比较无差异。2组患者的肝功能、肾功能、CK在用药后无明显异常。40 mg/d阿托伐他汀治疗12周时IL-6和TNF-α明显降低,而阿托伐他汀+依折麦布组治疗前、后的差异无统计学意义。结论 2种治疗方案的降脂疗效无差异,且均没有引起患者肝、肾功能及CK异常。较大剂量阿托伐他汀(40 mg/d)治疗可引起血清IL-6和TNF-α降低,对冠状动脉狭窄的冠心病患者可能有稳定斑块的作用。Objective To compare the influence and safety of administration of atorvastatin（40 mg/d） and combination of atorvastatin（10 mg/d） with ezetimibe（10 mg/d） in the treatment of coronary heart disease,and evaluate the influence of interleukin-6（IL-6） and tumor necrosis factor-alpha（TNF-α）.Methods 42 coronary heart disease patients（coronary artery stenosis between 50%-70% and no stent implantation） were classified to 2 groups： monotherapy group,40 mg atorvastatin（19 cases） and combined-therapy group,10 mg atorvastatin with 10 mg ezetimible（23 cases）.These patients continued their open-label administration for 12 weeks.Blood samples were collected before treatment,4 weeks after treatment and 12 weeks after treatment.The total cholesterol（TC）,triglyceride（TG）,low density lipoprotein cholesterol（LDL-C）,high density lipoprotein cholesterol（HDL-C）,liver function,renal function,creatine kinase（CK）,IL-6 and TNF-α were detected.Results Monotherapy reduced LDL-C by 37.82% [（1.94±0.49） mmol/L],and combined-therapy reduced LDL-C by 38.26% [（1.92±0.54） mmol/L] at 12 weeks.There was no obvious abnormality in liver function,renal function and CK after the treatment between the 2 groups.IL-6 and TNF-α levels significantly decreased in monotherapy after 12 weeks.However,there was no statistical difference in combined-therapy group before and after the treatment.Conclusions 10 mg/d ezetimibe coadministered with 10 mg/d atorvastatin in coronary heart disease patients has a lipid-lowering effect similar to 40 mg/d atorvastatin.Both had no abnormality in liver function,renal function and CK.Monotherapy may be superior to combined therapy in improving the levels of IL-6 and TNF-α.

关 键 词：血脂 白细胞介素-6 肿瘤坏死因子-Α 阿托伐他汀 依折麦布 冠心病 

分 类 号：R446.1[医药卫生—诊断学]