中国急性冠状动脉综合征患者应用20mg与10mg瑞舒伐他汀12周时低密度脂蛋白胆固醇达标率的对比研究  

Impact of Rosuvastatin 20 mg and 10 mg Daily for 12 Weeks on Goal Attainment Rates of Low-density Lipoprotein Cholesterol in Chinese Patients With Acute Coronary Syndrome

作　　者：孙赫 杨进刚[1] 张宇琼 马长生 胡大一[6] 杨艳敏[3] 王建旗[1] 杨毅[1] 葛兴[1] 岳巧敏[1] 崔雪晨 史旭波 SUN He;YANG Jingang;ZHANG Yuqiong;MA Changsheng;HU Dayi;YANG Yanmin;WANG Jianqi;YANG Yi;GE Xing;YUE Qiaomin;CUI Xuechen;SHI Xubo(Cardiovascular Center,Beijing Tongren Hospital,Capital Medical University,Beijing(100730),China)

机构地区：[1]首都医科大学附属北京同仁医院心血管中心,北京市100730 [2]中国医学科学院北京协和医学院,国家心血管病中心,阜外医院心内科 [3]中国医学科学院北京协和医学院,国家心血管病中心,阜外医院急重症中心 [4]北京市第一中西医结合医院心内科 [5]首都医科大学附属北京安贞医院心脏内科中心 [6]北京大学人民医院心血管病研究所

出　　处：《中国循环杂志》2020年第12期1181-1186,共6页Chinese Circulation Journal

摘　　要：目的:比较中国急性冠状动脉综合征(ACS)患者初始应用瑞舒伐他汀20 mg/d与10 mg/d治疗12周时的低密度脂蛋白胆固醇(LDL-C)达标率。方法:于2014年4月至2016年5月从全国16家医学研究中心共纳入505例缺血症状发作48 h内的ACS患者,随机分入瑞舒伐他汀20 mg/d组(RSV20组,n=254)或10 mg/d组(RSV10组,n=251),评估两组患者治疗第12周时根据2019年欧洲心脏病学会(ESC)血脂管理指南(LDL-C<1.4 mmol/L,且较基线水平降低≥50%)和2016年中国成人血脂异常防治指南(LDL-C<1.8 mmol/L或LDL-C降幅≥50%)定义的LDL-C达标率。结果:505例患者中,210例(41.6%)为ST段抬高型心肌梗死,85例(16.8%)为非ST段抬高型心肌梗死。RSV20组和RSV10组患者基线平均LDL-C水平分别为(3.07±0.49)mmol/L和(3.00±0.05)mmol/L,12周时LDL-C降幅分别为(43.23±1.89)%和(37.75±1.99)%(P<0.05)。根据2016年中国成人血脂异常防治指南,第12周时,RSV20组和RSV10组LDL-C达标率分别为73.4%和60.8%(P<0.05);根据2019年ESC血脂管理指南,RSV20组和RSV10组LDL-C达标率分别为27.0%和18.5%(P<0.05);两组依据2016年中国成人血脂异常防治指南的LDL-C达标率均明显高于依据2019年ESC血脂管理指南的LDL-C达标率(P均<0.001)。结论:依据2016年中国成人血脂异常防治指南和2019年ESC血脂管理指南,中国ACS患者应用20 mg/d瑞舒伐他汀12周时LDL-C达标率均高于10 mg/d瑞舒伐他汀。Objectives:The aim of this study was to compare the low-density lipoprotein cholesterol(LDL-C)goal attainment rates in Chinese acute coronary syndrome(ACS)patients after initial treatment with rosuvastatin 20 mg/d or 10 mg/d for 12 weeks.Methods:505 ACS patients from 16 national medical research centers were enrolled from April 2014 to May 2016 and randomly assigned to rosuvastatin 20 mg/d group(RSV20 group)or 10 mg/d group(RSV10 group)within 48 hours of ischemic symptoms onset.According to the 2019 European Society of Cardiology(ESC)lipid guideline,the target standards were defined as a LDL-C value of<1.4 mmol/L and a LDL-C reduction of 50%or more from baseline,while the criteria of the 2016 Chinese guidelines for prevention and treatment of dyslipidemia included a LDL-C value of<1.8 mmol/L or a LDL-C reduction of 50%or more from baseline.Both guidelines were used to evaluate the LDL-C goal attainment rates at 12 weeks after treatment.Results:There were 210 cases(41.6%)with ST-segment elevation myocardial infarction and 85 cases(16.8%)with non-STsegment elevation myocardial infarction.The baselines LDL-C value the two groups were(3.07±0.49)mmol/L and(3.00±0.05)mmol/L,respectively.After 12 weeks,the LDL-C reduction range was(43.23±1.89)%in RSV20 group and(37.75±1.99)%in RSV10 group(P<0.05).According to the 2016 Chinese guideline for dyslipidemia,the goal attainment rates after 12 weeks were 73.4%in RSV20 group and 60.8%in RSV10 group(P<0.05).According to the 2019 ESC lipid guideline,the goal attainment rates after 12 weeks were 27.0%in the RSV20 group and 18.5%in the RSV10 group(P<0.05).The goal attainment rates of LDL-C were significantly higher as evaluated by the 2016 Chinese guideline for dyslipidemia as compared to the 2019 ESC guideline for both RSV20 group and RSV10 group(both P<0.001).Conclusions:After 12 weeks treatment,the goal attainment rates of LDL-C,evaluated by both the 2016 Chinese guideline for dyslipidemia and the 2019 ESC lipid guideline,is significantly higher in rosuvastatin 20 mg/d group

关 键 词：急性冠状动脉综合征 低密度脂蛋白胆固醇 瑞舒伐他汀 强化降脂治疗 

分 类 号：R54[医药卫生—心血管疾病]