早期应用20 mg阿托伐他汀治疗急性冠脉综合征的可行性研究

Possibility of atorvastatin 20 mg/d in patients of acute coronary syndrome in early stage

关键词:  急性冠状动脉综合征  血脂  阿托伐他汀

Key words:  acute coronary syndrome (ACS)  lower density lipoprotein-cholesterol (LDL-C)  atorvastatin.

摘要:

［目的］ 探讨应用20 mg阿托伐他汀治疗急性冠状动脉综合征（ACS）的有效性和安全性。［方法］ 将107例ACS患者随机为两组：54例患者口服阿托伐他汀20 mg/d（20 mg组）；53例例患者口服阿托伐他汀10 mg/d（10 mg组）。随访6个月，观察两组患者调脂疗效、药物不良反应及住院期和出院后心脑血管事件发生情况。［结果］ 治疗6周后，20 mg组和10 mg组调脂幅度分别为：血清总胆固醇（TC）降低34.3%与24.7%，甘油三脂（TG）降低30.9%与23.2%，低密度脂蛋白胆固醇（LDL-C）降低32.4%与25.3%,高密度脂蛋白胆固醇（HDL-C）升高9.7%与5.4%，两组差异显著（P均<0.05）；总达标率55.6%与41.9%，TC达标率64.7%与49.6%，LDL-C达标率66.1%与48.1%，两组差异显著（P均<0.05）治疗6个月后两组调脂幅度分别为：TC降低37.9%与30.6%，TG降低38.5%与25.1%，LDL-C降低49.1%与29.9%, HDL-C升高16.8%与10.7%，两组差异显著（P均<0.05）；总达标率62.1%与44.1%，TC达标率72.5%与52.2%，LDL-C达标率71.2%与51.1%，两组差异显著（P均<0.05）。20　mg组住院期复发性心绞痛（AP）、心力衰竭、心律失常发生率明显低于10　mg组（P<0.05）；出院后复发性（AP）、非致死性心肌梗死（MI）、心力衰竭、需做经皮腔内冠状动脉成形术/冠脉旁路移植术（PTCA/CABG），因缺血发作需再住院和心律失常发生率20　mg组明显低于10　mg组（P<0.05）。两组间不良反应无显著差异（P>0.05）。［结论］ ACS早期应用阿托伐他汀20　mg/d治疗，能有效调降脂、提高达标率，减少住院期和随访期心脑血管事件发生，且安全可行。

Abstract:

［Objective］ To investigate the safety and efficacy of atorvastatin 20 mg/d to treat patients with acute coronary syndrome (ACS) in early stage. ［Methods］ The patients with ACS were randomly divided into: group　1 (n=54) given atorvastatin 20 mg/d and group　2 (n=53)10 mg/d at night, and the efficacy, the incidence of cardiovascular events and adverse reaction of the drug therapy were recorded in 6 months follow up. ［Results］For group 1 and group 2 , in 6 weeks after the treatment, the decreasing rates of the total plasma cholesterol (TC) were 34.3% and 24.7%，the decreasing rates of triglyceride(TG) 30.9% and 23.2%，the decreasing rates of low density lipoprotein (LDL-C) 32.4% and 25.3%, increasing rates of high density lipoprotein(HDL-C) 9.7% and 5.4%,; in 6 months after treatment, the decreasing rates of TC were while 37.9%and 30.6%，decreasing rates of TG 38.5% and 25.1%，decreasing rates of LDL-C 49.1%and 29.9%,while increasing rates of HDL-C 16.8% and 10.7%,there were significant difference between the each pair(P<0.05).Of group 1 and group 2 in 6 weeks after treatment , rates reaching to target of total blood-lipid goal level were 55.6% and 41.9%, on TC were 64.7% and 49.6%,LDL were 66.1% and 48.1%; in 6 months, rates reaching to target of total blood-lipid goal level were 62.1% and 44.1%, on TC were 72.5% and 52.2%, LDL were 71.2% and51.1%, there were significant difference between each pair (P<0.05). Comparing withgroup2 there were relatively lower recurrent rates of angina pectoris, congestive heart failure and arrhythmia occurrence in group1 during hospitalization　(P<0.05). There were significantly lower recurrent rates of angina pectoris, congestive heart failure, non-failure myocardial infarction, recanalization therapy with percutaneous transluminal coronary angioplasty (PTCA) or with coronary artery bypass surgery (CABG) and re-hospitalization in group1 during the 6 months following up　(P<0.05). The drug adverse reaction was not significantly different between two groups. ［Conclusions］ The early use of ato vastatin in dose of 20mg/d will be possible in safety, efficacy and tolerance.