不同剂量阿托伐他汀治疗老年冠心病的效果及对肝功能的影响  

Efficacy of Different Doses of Atorvastatin in the Treatment of Coronary Heart Disease in the Elderly and Their Effects on Liver Function

作　　者：王妍妍 路飞 胡涛 WANG Yan-yan;LU Fei;HU Tao(Department of Cardiovascular Medicine,Ankang Central Hospital,Ankang,Shaanxi 725000,China)

机构地区：[1]安康市中心医院心血管内科,陕西安康725000

出　　处：《解放军医药杂志》2020年第8期28-31,共4页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：陕西省科学技术研究发展计划项目(2017K15-02-792)。

摘　　要：目的探讨不同剂量阿托伐他汀治疗老年冠心病(CHD)的效果及对肝功能的影响。方法回顾性分析2017年1月—2018年9月我院收治的130例老年CHD患者的临床资料,根据治疗方案分为低剂量组62例和高剂量组44例。2组均给予常规治疗,低、高剂量组在此基础上分别加用阿托伐他汀20、40 mg。治疗3个月后比较2组临床疗效。比较2组治疗前后血脂[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)],炎性因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、可溶性细胞间黏附分子-1(sICAM-1)],血管内皮功能[肱动脉基础内径、肱动脉内皮依赖性舒张功能(FMD)、肱动脉非内皮依赖性舒张功能(NMD)]和肝功能指标。随访6个月记录并比较2组心血管不良事件(MACE)发生率。结果高剂量组治疗总有效率高于低剂量组(P<0.05)。2组治疗后TC、TG、LDL-C均低于治疗前,HDL-C均高于治疗前,且高剂量组变化幅度大于低剂量组(P<0.05)。2组治疗后hs-CRP、TNF-α、sICAM-1均低于治疗前,且高剂量组低于低剂量组(P<0.05)。高剂量组肝功能异常发生率高于低剂量组(P<0.05)。2组肱动脉基础内径、FMD、NMD均高于治疗前,且高剂量组高于低剂量组(P<0.05)。2组MACE发生率比较差异无统计学意义(P>0.05)。结论高剂量阿托伐他汀治疗老年CHD疗效更佳,但肝功能损伤发生风险增加,临床应用时需关注患者肝功能指标变化。Objective To investigate the efficacy of different doses of Atorvastatin in the treatment of coronary heart disease(CHD)in the elderly and their effects on liver function.Methods The clinical data of 130 elderly CHD patients admitted to our hospital from January 2017 to September 2018 were analyzed retrospectively.According to the treatment plan,they were divided into low-dose group(n=62)and high-dose group(n=44).Both groups were treated with conventional therapy,and the low-and high-dose groups were supplemented with 20 and 40 mg Atorvastatin respectively.At 3 months after treatment,the clinical efficacy of the two groups was compared.Before and after treatment,the levels of serum lipids(TC,TG,HDL-C,LDL-C),inflammatory factors(hs-CRP,TNF-α,sICAM-1),vascular endothelial function[(basic inner diameter of brachial artery,brachial flow-mediated dilation(FMD),brachial nitroglycein-mediated dilation(NMD)]and liver function indexes were compared.The incidence of major adverse cardiovascular events(MACE)was recorded and compared between the two groups during 6-month follow-up.Results The total effective rate of high-dose group was higher than that of low-dose group(P<0.05).After treatment,TC,TG and LDL-C of the two groups were lower than those before treatment,HDL-C were higher than those before treatment,and the change range of high-dose group was greater than that of low-dose group(P<0.05).The levels of hs-CRP,TNF-αand sICAM-1 were lower than those before treatment,which were lower in the high-dose group than in the low-dose group(P<0.05).The incidence of abnormal liver function in high-dose group was higher than that in low-dose group(P<0.05).The basic inner diameter,FMD and NMD of brachial artery in the two groups were higher than those before treatment,and those indicators in the high-dose group were higher than those in the low-dose group(P<0.05).There was no significant difference in the incidence of MACE between the two groups(P>0.05).Conclusion High-dose Atorvastatin has better efficacy in the treatment of CH

关 键 词：冠心病 阿托伐他汀 低密度脂蛋白胆固醇 高密度脂蛋白胆固醇 肿瘤坏死因子-α 心血管不良事件 肱动脉内皮依赖性舒张功能 

分 类 号：R541.4[医药卫生—心血管疾病]