不同调脂方案对冠状动脉介入治疗后胆固醇代谢标志物的影响  

Effects of different intensive lipid-lowering regimens on cholesterol metabolism makers and their ratios in patients after percutaneous coronary intervention

作　　者：段鹏[1] 谢英[2] 张小勇[1] 张西叶[1] 

机构地区：[1]暨南大学附属清远市人民医院胸心二区,广东清远511500 [2]首都医科大学附属安贞医院心内科

出　　处：《临床心血管病杂志》2012年第10期743-746,共4页Journal of Clinical Cardiology

摘　　要：目的:探讨不同强化调脂方案对经皮冠状动脉介入(PCI)术后患者胆固醇代谢标志物及其比值的影响。方法:将90例住院已行择期PCI的慢性稳定型冠心病患者随机分为3组,辛伐他汀40mg/d组(SI组)、辛伐他汀20mg/d+依折麦布10mg/d组(SI/EZ组)和阿托伐他汀20mg/d组(AT组),治疗随访12周,观察调脂疗效、胆固醇代谢标志物的变化和药物不良反应。结果:①3种调脂方案均能明显降低LDL-C、TC和TG水平,同时提高HDL-C水平;12周时,SI/EZ组LDL-C降低幅度(32.2%)和TG下降幅度(29.5%)均高于SI组和AT组,但差异无统计学意义。②治疗12周,3组血清胆固醇合成标志物水平均显著下降(均P<0.05),且SI组和AT组下降幅度明显大于SI/EZ组;胆固醇吸收标志物在SI/EZ组下降幅度达到11.9%～20.5%,SI组和AT组胆固醇吸收标志物水平则升高,且AT组升高幅度大于SI组。③3组均未出现有临床意义的肝酶和肌酶升高。结论:小剂量他汀联合依折麦布与较大剂量他汀相比调脂疗效无显著差异,且前者常见不良反应发生率较低,联合治疗可以明显改善患者的胆固醇代谢状况。Objective： To compare the efficacy between different intensive lipid-lowering regiments on choles- terol metabolism makers and their ratios in patients after percutaneous coronary intervention （PCI）. Method.. A total of 90 chronic stable angina patients post-PCI were randomized into three groups： group SI given 40 mg simv-astatin （n=30）, group SI/EZ given 20 nag simvastatin plus 10 mg ezetimible （n=30） and group AT given 20 nag atorvastatin （n= 30）. These patients continued their open-label administration for 12 weeks. The levels of Choles- terol （TC）, triglyceride （TG）, low-density lipoprotein cholesterol （LDL-C）, high-density lipoprotein cholesterol （HDI.-C）, and the cholesterol metabolism makers were determined at baseline, 4 and 12 weeks after treatment. Any adverse drug effects were recorded in 12 weeks. Result：（1） At 12 weeks, more reduction of LDL-C （- 32.2 % ） and TG reduction （- 29.5 %）was observed in group SI/EZ compared to other two groups, but there was no sig nificant difference. （2）At 12 weeks, levels of all the cholesterol synthesis makers significantly decreased in three groups （all P〈0.05）. The reductions of synthesis makers in group SI and AT were greater than group SI/EZ. The levels of cholesterol absorption makers significantly decreased in SI/EZ group （11.9%- 20.5%）, and increased in both SI and AT group, moreover, the latter was higher than the former. （3）None has increased pep- tase or creatase. Conclusion：Low-dose statin plus ezetimible had less adverse drug reaction and more significantly improve the cholesterol metabolism compared with high-dose statin treatment.

关 键 词：冠状动脉疾病 调血脂药 血管成形术 经腔 经皮冠状动脉 

分 类 号：R541.4[医药卫生—心血管疾病]