不同民族动脉粥样硬化性心血管疾病患者中等剂量他汀类药物治疗的疗效差异研究  

Study on the Efficacy Differences of Moderate-dose Statin Therapy in Patients with Atherosclerotic Cardiovascular Disease among Different Ethnic Groups

作　　者：罗思富 金梦龙 苏比努尔·居热提 刘紫阳 付真彦[1] LUO Sifu;JIN Menglong;SUBINUER·Jureti;LIU Ziyang;FU Zhenyan(Department of Coronary Heart DiseaseⅡ,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学第一附属医院冠心病二科,新疆维吾尔自治区乌鲁木齐市830000

出　　处：《中国全科医学》2024年第36期4522-4526,4533,共6页Chinese General Practice

基　　金：科技部“十四五”国家重点研发计划项目(2021FYC2500605);新疆维吾尔自治区科学技术厅-科技创新领军人才项目(2022TSYCLJ0030);新疆维吾尔自治区重点研发计划项目(2022B03022-4);省部共建中亚高发病成因与防治国家重点实验室开放课题项目(SKL-HIDCA-2022)。

摘　　要：背景他汀类药物是降脂疗法的基石,中等剂量的他汀类药物是中国人群脂质管理的首选治疗策略。然而,尽管他汀类药物在降低胆固醇和预防心血管疾病的疗效已经得到广泛认可,但不同族群患者治疗反应存在明显差异。目的探讨汉族和维吾尔族患者在中等剂量他汀类药物治疗中的疗效差异,以指导个体化治疗方案的制订。方法纳入2012—2022年于新疆医科大学第一附属医院心脏中心首次经冠状动脉造影明确诊断为动脉粥样硬化性心血管疾病(ASCVD)的780例患者为研究对象,收集患者基线资料和实验室检查结果。结果共纳入780例ASCVD患者,其中汉族408例,维吾尔族372例,汉族与维吾尔族患者平均年龄和性别构成比较,差异有统计学意义(P<0.05)。他汀类药物治疗前汉族患者总胆红素(Tbil)、白蛋白(ALB)、糖化血红蛋白(HbA1c)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)、高低密度脂蛋白血症比例高于维吾尔族患者,丙氨酸氨基转移酶(ALT)、低高密度脂蛋白血症、低载脂蛋白A1血症、高脂蛋白a血症比例低于维吾尔族患者(P<0.05);他汀类药物治疗后汉族患者Tbil、天冬氨酸氨基转移酶、ALB、HbA1c、HDL-C、ApoA1水平高于维吾尔族患者,ALT、TC、低密度脂蛋白胆固醇(LDL-C)、ApoB、低高密度脂蛋白血症、低载脂蛋白A1血症、高载脂蛋白B血症比例低于维吾尔族患者(P<0.05)。中等剂量他汀类药物治疗后,汉族患者TC、HDL-C、LDL-C、ApoB降低水平高于维吾尔族(P<0.05);TC、LDL-C、ApoB降低程度高于维吾尔族,HDL-C升高程度低于维吾尔族(P<0.05)。以LDL-C下降幅度作为分组标准,将患者分为敏感组(n=124)、抵抗组(n=104)、中间组(n=552)。抵抗组汉族42例、维吾尔族62例,敏感组汉族78例、维吾尔族46例,中间组汉族288例、维吾尔族264例,3组民族分布比较,差异有统计学意义(χ^(2)=11.51Background Statins are the cornerstone of lipid-lowering therapy and moderate-dose statin therapy is the preferred treatment strategy for lipid management in the Chinese population.Despite the widely recognized efficacy of statins in reducing cholesterol levels and preventing cardiovascular diseases,there are significant differences in treatment responses among patients from different ethnic groups.Objective To explore the differences in therapeutic efficacy between Han and Uyghur patients under moderate-dose statin therapy to guide the formulation of individualized treatment plans.Methods A total of 780 patients diagnosed with atherosclerotic cardiovascular disease(ASCVD)by coronary angiography at the First Affiliated Hospital of Xinjiang Medical University's Cardiac Center from 2012 to 2022 were included in the study.Baseline data and laboratory examination results of the patients were collected.Results A total of 780 ASCVD patients were included,with 408 Han and 372 Uyghur patients.The mean age and gender composition of the two groups were statistically significant(P<0.05).Prior to statin therapy,Han patients had higher levels of total bilirubin(Tbil),albumin(ALB),glycated hemoglobin(HbA1c),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),apolipoprotein A1(ApoA1),apolipoprotein B(ApoB),and proportions of hypertriglyceridemia and hypercholesterolemia compared to Uyghur patients.Conversely,Han patients had lower levels of alanine aminotransferase(ALT),hypoalphalipoproteinemia,hypoapolipoproteinemia A1,and hyperlipoproteinemia a compared to Uyghur patients(P<0.05).After statin therapy,Han patients had higher levels of Tbil,aspartate aminotransferase,ALB,HbA1c,HDL-C,ApoA1,and lower levels of ALT,TC,low-density lipoprotein cholesterol(LDL-C),ApoB,hypoalphalipoproteinemia,hypoapolipoproteinemia A1,and hyperapolipoproteinemia B compared to Uyghur patients(P<0.05).After medium-dose statin therapy,the reduction levels of TC,HDL-C,LDL-C,and ApoB in Han patients were higher than those in Uyghurs(P<0.05);

关 键 词：高脂血症 动脉粥样硬化 阿托伐他汀 瑞舒伐他汀 治疗效果 

分 类 号：R589.2[医药卫生—内分泌]