早期慢性肾脏病合并冠心病强化他汀治疗的研究

The Effect of Intensive Lovastatin on Patients with Earlier Stage Chronic Kidney Disease Combined with Coronary Heart Disease

目的探讨强化洛伐他汀治疗对早期慢性肾脏病(CKDI-II)合并冠心病患者肾功能的影响。方法选择2007年1月-2009年1月西丽人民医院就诊早期慢性肾脏病合并冠心病患者62例并随机分为治疗组和对照组。对照组给予常规治疗及洛伐他汀20 mg/d,强化治疗组在上述治疗的基础上将洛伐他汀加至40 mg/d。每3个月比较两组患者血压、血总胆固醇(TC)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)、甘油三酯(TG)、尿蛋白定量(Upr)、血肌酐(Scr)、C反应蛋白(CRP)、肝功能等指标。结果两组治疗后较治疗前TC、TG、LDL-C均明显下降,治疗前后差异有统计学意义(P<0.05,P<0.01),但组间无显著差异,HDL-C略上升,但差异无统计学意义(P>0.5)。两组治疗后Upr和Scr均明显下降(P<0.05),强化治疗组Upr和Scr下降比对照组明显(P<0.05,P<0.01)。结论强化洛伐他汀在治疗慢性肾脏病合并冠心病中应用安全,能够更好地保护肾功能。

Objective To investigate the effect of intensive Lovastatin therapy on patients with earlier stage chronic kidney disease（ CKD stage（1-2） combined with coronary heart disease（CVD）. Methods 62 patients with CKD Ⅰ-Ⅱ combined with CHD were divided into two groups, the controlled group received conventional therapy and Lovastatin 20 mg/d,while the dose of Lovastatin in treated group was 40 mg/d. The blood pressure, Total cholesterol （TC）, triglyceride（TG） ,low-density lipoprotein cholesterol（ LDL-C）, high-density lipoprotein cholesterol （ HDL-C ）, Urine protein （Upr） , serum creatinine （Scr） concentration, Creac- tion protein（CRP） and liver function of the two groups were compared every 3 months. Results TC,TG,LDL-C concentration were significantly decreased after one year therapy in both groups compared with that before therapy resPectively（P 〈0.05 or 〈 0.01 ） and they were even lower in treated group than that in control group ,but for HDL-C there was no significantly difference after therapy in both groups. Upr and Scr concentration were decreased gradually after therapy and significantly lower after 12 months in both groups（P 〈0.05 ,P 〈0.01 ）. And Upr and Scr after therapy were significantly lower in treated group than those in control group（P 〈 0.05 ,P 〈 0.01 ）. Conclusion Intensive Lovastatin therapy were safe and had more renoprotective effects for patients with earlier CKD combined with CHD.