依折麦布联合阿托伐他汀对LDL—C未达标急性冠脉综合征患者易损斑块的影响  

Influence on vulnerable plaque of ACS patients with disqualified index of LDL - C by ezetimibe combined with atorvastatin

作　　者：李朝晖[1] 田峰[2] 刘新民[3] 

机构地区：[1]河南科技大学第二附属医院心内科,河南洛阳471000 [2]中国人民解放军总医院心内科,北京100853 [3]首都医科大学附属北京安贞医院心内科,北京100029

出　　处：《中国急救医学》2017年第11期1024-1028,共5页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨依折麦布联合阿托伐他汀对低密度脂蛋白胆固醇（LDL—C）未达标急性冠脉综合征（ACS）患者血脂水平及易损斑块的影响。方法选取经规律口服阿托伐他汀治疗LDL—C未达标的ACS患者为研究对象，随机分组，观察组有效受试者68例、对照组65例。在ACS常规和综合治疗的基础上，对照组采用阿托伐他汀强化降脂方案，予以阿托伐他汀钙片口服40mg／d；观察组采用阿托伐他汀联合依折麦布降脂方案治疗，予以阿托伐他汀钙片20mg／d和依折麦布片口服10mg／d，两组均以4周为1个疗程。比较两组治疗前、治疗3个疗程后的血脂及血清高敏c一反应蛋白（hs—CRP）水平，治疗前[冠状动脉造影（CAG）后]、治疗6个疗程后的血管内超声（IVUS）检查指标。随访12个月，记录主要心血管不良事件（MACE）及药物副作用。结果治疗3个疗程后，两组总胆固醇（Tc）、LDL—C及血清hs—CRP水平均降低（t=4．55—7．13，P〈0．05或P〈0．01）；观察组TC、LDL—C及血清hs—CRP水平均降低（t=3．61～4．70，P〈0．05）。治疗6个疗程后，两组最小管腔面积、纤维斑块比例均增加，斑块面积、斑块负荷及软斑块比例均减少（t=4．36—6．51，P〈0．05或P〈0．01）；观察组最小管腔面积、纤维斑块比例均大于对照组，斑块面积、斑块负荷及软斑块比例均小于对照组（t=3．55～4．64，P〈0．05）。随访期间，观察组再发心绞痛（6．06％VS．20．97％）、再发心肌梗死（3．03％VS．14．52％）比例均低于对照组（X。=6．17、5．37，P〈0．05）。除对照组2例肝功能损伤外，两组其余患者均未见明显的药物副作用。结论依折麦布联合阿托伐他汀用于LDL—C未达标的ACS患者具有较好的协同作用和临床疗效，进一步降低了患者的LDL—C水平，增强了易损斑块的稳定性，降低了MACE的风险，且具有较高的安�Objective To explore the serum lipid level and influence on vulnerable plaque of acute coronary syndrome （ACS） patients with disqualified index of low density lipoprotein -cholesterol （LDL - C ） by ezetimibe combined with atorvastatin, to provide references to its clinical diagnosis, treatment and prognosis evaluation. Methods ACS patients with disqualified index of LDL - C after regular treatment by atorvastatin were selected as research cases, and were randomly divided into two groups, and with 68 effective cases in observation group, 65 cases in control group. Based on ACS＇ conventional and comprehensive treatment, intensive lipid lowing therapy were adopted in control group with atorvastatin of 40 mg/d, yet patients in observation group were treated by ezetimibe （ 10 mg/d） combined with atorvastatin （20 mg/d）, and they were all treated for 1 courses with 4 weeks. Serum lipid and high- sensitivity C- reactive protein （hs -CRP） levels were compared between two groups before treatment and 3 courses after treatment, and intravaseular ultrasound （IVUS） index were compared between two groups before treatment （after CAG） and 6 courses after treatment. Major adverse cardiac events （MACE） and drug reactions were recorded during follow - up for 12 months. Results 3 courses after treatment, two groups＇ serum TC, LDL - C and hs - CRP levels were all decreased （ t = 4.55 ± 7.13, P 〈0.05 or P 〈0.01 ） , and observation group＇s serum TC, LDL - C and hs - CRP levels were all lower than those in control group （ t = 3.61± 4.70, P 〈 0.05 ）. 6 courses after treatment, two groups＇ minimum lumen area and fibrous plaque＇s proportion were all increased, and plaque area, plaque burden and soft plaque＇ s proportion were all decreased （ t = 4.36 - 6.51, P 〈0. 05 or P 〈 0.01 ）, and observation group＇s minimum lumen area and fibrous plaque＇s proportion were both higher than those in control group, and plaque area, plaque burden and soft plaque＇s proportion were both

关 键 词：急性冠脉综合征(ACS) 血脂 易损斑块 阿托伐他汀 依折麦布 

分 类 号：R972.6[医药卫生—药品]