不同剂量辛伐他汀治疗冠心病的临床疗效观察

Effect of simvastatin dosage in treating coronary heart disease

目的观察冠状动脉粥样硬化性心脏病患者使用不同剂量辛伐他汀的疗效、安全性、对血脂斑块生长及心血管事件的影响。方法将血脂总胆固醇(TC)≥4.68mmol/L和(或)低密度脂蛋白胆固醇(LDL-C)≥2.6 mmol/L,B超检查存在不同程度颈动脉斑块形成的临床诊断为冠心病的患者(126例)按随机原则分别入选辛伐他汀80mg组(强化治疗剂量)、40mg组与20mg组(常用处方剂量)。于服药后12周及24周复查血脂,B超复查颈动脉斑块,并对心血管事件作随访登记。结果辛伐他汀80mg、40mg与20mg均能有效地降低冠心病患者血清TC及LDL-C水平,其中80mg剂量组在降TC和降LDL-C及减少心血管事件发生率方面均明显优于20mg剂量组,40mg剂量组疗效介于两组之间,三者间均存在显著差异。80mg剂量组的颈动脉斑块缩小,而40mg剂量组及20mg剂量组无颈动脉斑块缩小。三种剂量在不良反应方面无明显差异。结论辛伐他汀强化治疗剂量在治疗冠心病方面明显优于常用处方剂量;强化治疗剂量可以逆转颈动脉斑块发展。

Objective To observe the efficacy and safety of three different dosage of simvastatin in the treatment of patients with coronary heart disease and the effect in treating carotid plaques and risk of major events. Methods One hundred and twenty-six patients with different degrees of carotid plaques detected by ultrasonic, whose total cholesterol （TC） was over 4.68mmol/L or low-density lipoprotein cholesterol （ LDL-C） over 2.6 mmol/L, were entered the study and randomized to three groups： 80mg-group （ intensification dosage, n = 42 ）, 40mg-group（ n = 39 ） and 20mg-group （ common prescription dosage, n = 45）. At the 12th week and the 24th week, lipid levels were determined and carotid plaques were detec ted by ultrasonic again. During the following-up, all cardiovascular events and adverse events were recorded. Results Levels of LDL-C and TC reduced significantly in 80mg-group, 40mg-group and 20mg-group. While the effect in 80mg-group was better than that in the other groups. There was lower rate of cardiovascular events in 80mg-group than that in the other groups （P 〈 0.05）. The plaques in 80mg-group were significantly reduced （P 〈0.01） compared with those before treatment. There was little difference in clinical adverse events between in 80mg-group and in the other groups. Conclusion Intensification dosage of the HMG-CoA reductase inhibitor simvastatin is better than common prescription dosage in treating coronary heart disease and the former can converse the carotid plaques development.