轻度氨基转移酶升高冠心病患者调节血脂药应用研究  

Application of Lipid-Regulating Drugsin Coronary Heart Disease Patients with Mild Elevation of Hepatic Transaminases

作　　者：马英杰 陶小妹 马丽萍 MA Yingjie;TAO Xiaomei;MA Liping(Dept. of Pharmacy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China;Beijing Key Laboratory of Bio-Characteristic Profiling for Evaluation of Rational Drug Use, Beijing 100038, China;International Cooperation & Joint Laboratory of Bio-Characteristic Profiling for Evaluation of Rational Drug Use, Beijing 100038, China;Clinical Trial Agency Office, Peking University Shougang Hospital, Beijing 100144,China)

机构地区：[1]首都医科大学附属北京世纪坛医院药剂科,北京100038 [2]临床合理用药评价北京市重点实验室,北京100038 [3]临床合理用药评价国际合作联合实验室,北京100038 [4]北京大学首钢医院临床试验机构办,北京100144

出　　处：《中国医院用药评价与分析》2020年第5期533-535,539,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：北京市优秀人才“青年拔尖团队”项目(No.2018000021223TD09)。

摘　　要：目的:探讨他汀类药物致轻度血清氨基转移酶升高冠心病患者调节血脂药的治疗方案。方法:选取2018年10—12月符合纳入与排除标准的轻度氨基转移酶升高冠心病患者93例,根据患者发生无症状性孤立性轻度氨基转移酶水平升高后医师处方他汀类药物情况,将患者分为A组(停用他汀类药物)33例、B组(未调整调脂治疗方案)33例和C组[调整他汀类药物治疗方案(种类或剂量)]27例。记录三组患者的基本情况、药物使用情况、他汀类药物给药日剂量和低密度脂蛋白胆固醇(LDL-C)水平。结果:纳入的93例患者氨基转移酶水平均在升高后3个月内恢复至正常范围。在氨基转移酶升高前处方比例最大的3种他汀类药物依次为匹伐他汀、阿托伐他汀和瑞舒伐他汀;氨基转移酶升高后处方比例最大的3种他汀类药物依次为匹伐他汀、普伐他汀和阿托伐他汀,普伐他汀处方比例增加13.87%。A、B和C组患者的LDL-C达标率分别为21.21%(7/33)、60.61%(20/33)和37.04%(10/27),三组组间差异有统计学意义(P<0.05);两两比较,A组患者的LDL-C达标率明显低于B组(P<0.017),A、C组患者的差异无统计学意义(P>0.017),B、C组患者的差异无统计学意义(P>0.017)。电话访谈显示,A组61.90%(13/21)的患者按照处方服药,B组78.26%(18/23)的患者按照处方服用药物,C组52.94%(9/17)的患者按照处方服用药物。实际没有继续服用高强度他汀类药物的患者。结论:冠心病患者服用他汀类药物出现无症状性孤立性轻度氨基转移酶水平升高,临床实际应用中存在停止使用他汀类药物或调整他汀类药物治疗方案的情况,影响患者用药依从性和LDL-C达标率。ABSTRAT OBJECTIVE:To probe into the treatment regimen of coronary heart disease patients with mild elevation of hepatic transaminases induced by statins.METHODS:Totally 93 cases of coronary heart disease patients with mild elevation of hepatic transaminases met the inclusion and exclusion criteria and admitted from Oct.to Dec.2018 were extracted to be divided into 33 cases in the group A(withdrawal of statins),33 cases in the group B(without adjustment of lipid-regulating therapy group)and 27 cases in the group C[with adjustment of lipid-regulating therapy(categories or doses)]according to patients'prescription of statins after asymptomatic solitary mild elevation of hepatic transaminases.The general data,application of drugs,daily dose of statins and low density lipoprotein cholesterin(LDL-C)level of three groups were recorded.RESULTS:The hepatic transaminases levels of 93 patients returned to the normal range within 3 months after elevation.The largest proportion of prescriptions of statins before elevation in hepatic transaminases were pivastatin,atorvastatin and rosuvastatin.The largest proportion of prescriptions of statins afer elevation of hepatic transaminaseswere pitvastatin,pravastatin and atorvastatin.The proportion of prescriptions for pravastatin increased by 13.87%.The compliance rates of LDL-C in group A,B and C were respectively 21.21%(7/33),60.61%(20/33)and 37.04%(10/27),with statistically significant differences(P<0.05).The compliance rate of LDL-C in group A was significantly lower than that in group B(P<0.017).The difference of compliance rate of LDL-C in group A and C was not statistically significant(P>0.017),and the difference in groups B and C was not statistically significant(P>0.017).According to the telephone interview,61.90%(13/21)of patients in group A took medicine according to prescription,78.26%(18/23)of patients in group B took medicine according to prescription,and 52.94%(9/17)of patients in group C took medicine according to prescription.No patients actually continued to take hi

关 键 词：氨基转移酶 冠心病 他汀类药物 低密度脂蛋白胆固醇 

分 类 号：R972.6[医药卫生—药品]