他汀类药物在治疗急性心肌梗死的临床应用和研究进展  

Clinical application and research progress of statins in the treatment of acute myocardial infarction

作　　者：谭志晖 郭瑞威[2] 谭志胜[2] 刘丹 郭硕 TAN Zhihui;GUO Ruiivei;TAN Ziisheng;LIU Dan;GUO Shuo(DeparLmenL of GeriaLrics,Kunming General HospiLal of Chengdu MiliLary Command,Yunnan Province,Kunming 650032,China;DeparLmenL of Cardiology,Kunming General HospiLal of Chengdu MiliLary Command,Yunnan Province,Kunming 650032,China;DeparLmenL of General Medicine,Kunming Tongren HospiLal,Yunnan Province,Kunming 650032,China;DeparLmenL of InLernal Medicine,Kunming Guangfu HospiLal,Yunnan Province,Kunming 650032,China)

机构地区：[1]成都军区昆明总医院老年科,云南昆明650032 [2]成都军区昆明总医院心血管内科,云南昆明650032 [3]昆明同仁医院综合内科,云南昆明650032 [4]昆明广福医院内科,云南昆明650032

出　　处：《中国医药导报》2018年第20期21-24,共4页China Medical Herald

基　　金：国家自然科学基金资助项目(81370383);云南省中青年学术和技术带头人后备人才基金项目(2014HB236)

摘　　要：他汀类药物,即3-羟基-3甲基戊二酰辅酶A(HMG-Co A)还原酶抑制药,是目前最有效的降脂药物,不仅能强效地降低总胆固醇(TC)和低密度脂蛋白(LDL),而且能一定程度上降低三酰甘油(TG),还能升高高密度脂蛋白(HDL)水平,被称为较全面的调脂药。他汀类药物的作用机制是通过竞争性抑制内源性胆固醇合成限速酶HMG-Co A还原酶,阻断细胞内羟甲戊酸代谢途径,使细胞内胆固醇合成减少,从而反馈性刺激细胞膜表面LDL受体数量和活性增加,使血清胆固醇清除增加水平降低,临床上主要用于降低胆固醇尤其是低密度脂蛋白胆固醇,治疗动脉粥样硬化,现已成为冠心病预防和治疗的最有效药物。近年来,研究发现他汀类药物具有多方面非降脂作用,其中包括抑制动脉粥样硬化与血栓形成,还具有缓解器官移植后的排异反应、治疗骨质疏松症、抗肿瘤、抗老年痴呆等多种作用。而本文结合急性心肌梗死的发病机制,阐述他汀类药物对急性心肌梗死的作用机制,并就其对急性心肌梗死的系列作用进行综述,为临床用药提供理论依据和指导。SLaLins,Lhe 3-hydroxyl-3 meLhyl amyl Lwo acyl coenzyme A(HMG-CoA)reducLase inhibiLor,are Lhe mosL effecLive lipid lowering drugs aL presenL.IL can noL only reduce Lhe LoLal cholesLerol(TC)and Lhe low densiLy lipoproLein(LDL),buL also reduce Lhe TG and increase Lhe densiLy lipoproLein(HDL)Lo a cerLain exLenL,iL is called a comprehen-sive lipid-lowering drug.The mechanism of sLaLins is Lo synLhesize Lhe enzyme HMG-CoA reducLase by compeLiLive in-hibiLion of endogenous cholesLerol,blocking Lhe inLracellular paLhway of hydroxymeLhylene valeraLe meLabolism,reduc-ing Lhe cholesLerol synLhesis in cells,and increasing Lhe number and acLiviLy of LDL recepLor on Lhe surface of Lhe membrane on Lhe membrane,so LhaL serum cholesLerol is increased,which is mainly used Lo reduce cholesLerol,espe-cially low densiLy lipoproLein cholesLerol in clinic,and Lo LreaL aLherosclerosis,is Lhe mosL effecLive drug for Lhe preven-Lion and LreaLmenL of coronary hearL disease.In recenL years,iL has been found LhaL sLaLins have many non lipid-lower-ing effecLs,including inhibiLion of aLherosclerosis and Lhrombosis,remission of rejecLion afLer organ LransplanLaLion,LreaLmenL of osLeoporosis,anLiLumor,and anLi Alzheimer's disease.BuL,combined wiLh Lhe paLhogenesis of acuLe my-ocardial infarcLion,Lhis arLicle expounded Lhe mecha-nism of sLaLins on acuLe myocardial infarcLion,and sum-marized iLs serial role in acuLe myocardial infarcLion,so as Lo provide LheoreLical basis and guidance for clinical medicaLion.

关 键 词：他汀类药物 急性心肌梗死 综述 临床指导 

分 类 号：R541[医药卫生—心血管疾病]