阿托伐他汀非延续性治疗对冠心病伴高脂血症病人血脂及内皮功能的影响

THE EFFECTS OF ATORVASTAIN ON PATIENTS WITH CORONARY HEART DISEASE AND HYPERLIPEMIA

目的通过观察冠心病伴高脂血症病人使用阿托伐他汀治疗前、后及中途停药后的血脂、血清一氧化氮(NO)、血浆内皮素(ET)水平的变化,探讨他汀类药物在冠心病防治中延续性治疗的意义。方法从门诊、住院病人中选择冠心病伴高脂血症病人50例作为研究对象,给予阿托伐他汀20 mg口服治疗,分别于清晨空腹抽取服药前、服药4周后、停药2周时的肘静脉血,检测血总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、NO、ET的水平。结果阿托伐他汀治疗4周后病人TC、LDL水平明显降低,停用阿托伐他汀2周后,所有病人的TC和LDL水平较停药前升高,但仍低于服药前水平(F=233.58、95.71,P<0.05);服药4周血清NO水平明显升高,然而停用阿托伐他汀2周后,NO水平明显降低,甚至低于服药前水平(F=364.98,P<0.05);服药4周血浆ET明显降低,停药2周ET水平则明显回升(F=98.39,P<0.05)。结论阿托伐他汀对冠心病伴高脂血症病人的血管内皮功能有明显改善作用,但当突然停止阿托伐他汀治疗2周后对病人的血脂水平及内皮功能改善作用明显减弱,甚至导致血管内皮功能的进一步恶化。

Objective To assess the effects of atorvastain on therapy of coronary heart disease （CHD） by observing the blood fat, serum NO, and plasma ET before, after and half-way withdrawal of medication. Methods Fifty CHD patients with hyperlipemia were enrolled from outpatients and inpatients. They were given 20 mg atorvastatin orally. Fasting blood was taken from ulnar vein before medication, four weeks after therapy, and two weeks after drug withdrawal. Total cholesterol （TC）, tria cylglyeerol, high-density lipoprotein cholesterol （HDL）, low-density lipoprotein cholesterol （LDL）, nitrogen monoridum （NO）, and endothelin （ET） levels were detected. Results TC and LDL levels declined markedly after four weeks of atorvastin treat ment, the above items rose after two weeks of discontinue, but still lower than that before medication, （F= 233.58,95.71;P〈0.05）. For NO, which rose obviously after four-week medication, and decreased dramatically two weeks after drug withdrawal and even lower than that before treatment （F= 364.98, P〈0. 05）. For ET, which lowered significantly after four week medication, and returned manifestly two weeks after drug withdrawal （F=98.39,P〈0.05）. Conclusion Atorvastain is effective in impro ving the function of blood vessel endothelium （BVE）, but the improvement was decreased obviously when sudden withdrawal of the medicine for two weeks which may result in even worse impact on BVE function.