高敏C反应蛋白联合低密度脂蛋白胆固醇作为他汀治疗靶目标的临床研究  

High-sensitivity C-reactive protein combined with low-densitylipoprotein cholesterol are the dual targets of statin therapy

作　　者：方明[1] 李新明[1] 柳亮[1] 王娟[1] 王天松 

机构地区：[1]同济大学附属东方医院心内科,上海200120 [2]三亚市人民医院心内科

出　　处：《临床心血管病杂志》2012年第3期200-203,共4页Journal of Clinical Cardiology

基　　金：上海市浦东新区领先人才基金项目资助(No:PWR12010-03)

摘　　要：目的:探讨急性冠状动脉综合征(ACS)介入术后,以高敏C反应蛋白(hs-CRP)联合低密度脂蛋白胆固醇(LDL-C)作为他汀治疗靶目标的可行性。方法:2007-01-2009-01期间,连续纳入ACS患者400例,随机分为A、B组(每组200例),常规行介入手术,术后每组给予阿托伐他汀40mg/d,口服1个月;此后给予阿托伐他汀20mg/d,口服维持。A组治疗靶目标为LDL-C<2.07mmol/L,B组治疗靶目标为LDL-C<2.07mmol/L且hs-CRP<3mg/L,观察2组LDL-C、hs-CRP指标变化,随访6个月、12个月、18个月主要心血管不良事件(MACE:全因性死亡、非致死性心肌梗死、靶血管再次血运重建)。结果:2组患者基线特征差异无统计学意义;2组在18个月时均达到各自治疗靶目标;2组LDL-C水平差异无统计学意义;hs-CRP在12个月和18个月随访时差异有统计学意义,分别为(5.96±3.51)和(3.85±2.23)mg.L-1(P<0.05),(4.68±2.81)和(2.05±0.91)mg.L-1(P<0.05);在18个月随访时,2组靶血管再次血运重建率和MACE发生率差异有统计学意义,分别为8.6%和3.6%(P<0.05),16.8%和9.7%(P<0.05)。A组发生MACE的概率是B组的1.73倍(HR=1.73,95%CI:1.12～5.27,P=0.025)。结论:ACS介入术后,对于血脂已达标但炎症仍较为活跃患者,hs-CRP和LDL-C双重达标可进一步减少MACE发生,降低残余心血管风险。hs-CRP可能是他汀治疗的另一有效靶目标。Objective：To observe the efficiency of the treatment that high-sensitivity C-reactive protein（hs-CRP） combined with low-density lipoprotein cholesterol（LDL-C） were treated as the dual targets of statin therapy in patients with acute coronary syndrome（ACS）. Method：From 2007 to 2009,400 patients with ACS were randomly divided into group A and group B.Both groups after percutaneous coronary intervention were treated with atorvastatin 40 mg/d for 1 month and then with atorvastatin 20 mg/d to maintain.The targets of group A are LDL-C2.07 mmol/L and the targets of group B are LDL-C2.07 mmol/L and hs-CRP3 mg/L.We followed the MACE（the combined incidence of death,myocardial infarction and repeat revascularization） at 6,12 and 18 months after operation. Result：Two groups had similar baseline characteristics and achieved their different targets at 18 months.There was no difference in LDL-C,but a significant difference was found in hs-CRP at 12 months [（5.96±3.51） vs（3.85±2.23）mg·L^-1P〈0.05] and 18 months [（4.68±2.81） vs（2.05±0.91）mg·L^-1P〈0.05].There was a significant difference in repeat revascularization（8.6% vs 3.6%,P〈0.05） and MACE（16.8% vs 9.7%,P〈0.05） at 18 months.The probability of MACE in group A was 1.73 times that of in（delete） group B. Conclusion：Compared to LDL-C as the single target,the treatment of hs-CRP combined with LDL-C as the dual target of statin therapy in patients with ACS significantly reduced the incidence of MACE and residual cardiovascular risk,hs-CRP may be another target of statin therapy.

关 键 词：冠心病 高敏C反应蛋白 低密度脂蛋白胆固醇 双重靶目标 

分 类 号：R541.4[医药卫生—心血管疾病]