急性冠状动脉综合征非介入患者强化阿托伐他汀治疗疗效观察

The clinical study on the efficacy of intensive lipid-lowering therapy in patients with Non-ST-segment elevation acute coronary syndromes

目的 评估对于未行血运重建的非ST段抬高的急性冠状动脉综合征（NSTE-ACS）患者强化阿托伐他汀治疗的效果和安全性。方法 选取未行血运重建的NSTE-ACS患者68例，均在常规二级预防治疗的基础上，其中34例（强化组）予阿托伐他汀40mg/d，1个月后20mg/d维持；另34例（对照组）予阿托伐他汀10mg/d，疗程至少6个月。分别于服药前及服药后6个月行血脂、肝功能、高敏C反应蛋白（hs-CRP）的检测，同时记录两组患者心绞痛发作次数、发作时间及严重心血管事件。结果 两组患者治疗后6个月TC、LDL-C、hs-CRP均较治疗前明显改善（P＜0.05或0.01）；与对照组比较，强化组治疗后6个月TC、LDL-C、hs-CRP均明显改善（P＜0.05）。住院期间强化组死亡2例，对照组死亡3例，病死率差异无统计学意义（P ＞0.05）；出院后强化组心脏不良事件发生率显著低于对照组（P＜0.01）。两组患者治疗后心绞痛发作次数及持续时间均较治疗前明显减少（P＜0.05），而且强化组治疗后心绞痛发作次数、持续时间较对照组亦明显减少（P＜0.05）。结论 对于未行血运重建的NSTE-ACS患者，早期强化阿托伐他汀治疗，能明显改善临床症状，减少并发症和心脏不良事件的发生，其安全性和低剂量相当。

Objective To study the clinical efficacy and safety of atorvastatin （40mg/day）in patients with non-ST-segment elevation acute coronary syndromes （NSTE-ACS）. Methods 68 cases of NSTE-ACS patients, were randomly divided into treatment group 34 cases and the control group 34 cases.Two groups of patients had conventional treatment（aspirin,isosorbide mononitrate,clopidogrel,etc. ）.Patients in the treatment group took atorvastatin 40 mg per clay for one month, then 20 mg to maintain, while patients in the control group took atorvastatin 10 mg per day at all time.The course of treatment lasted 6 months. Blood cholesterol, liver function, high reactive c-reactive protein （hs- CRP） changes were recorded before treatments and after 1 month, 3 months, 6 months of treatments. Anginapectoris as well as serious cardiovascular events（recurrence myocardial infarc- tion,cardic death,severe heart failure,ect）, were also recorded. Results The total cholesterol, low density lipoprotein cholesterol （LDL-C） and hs- CRP were significantly improved in both two groups after 6 months of treatment （P〈0.05 or 0.01）. The incidence of adverse cardiovascular events was significantly lower in intensive group during treatment （P〈0.05）. Frequency and duration of angina pectoris were also decreased in both groups （P〈0.05）, especially in intensive group （P〈0.05）.Lower incidence of adverse cardiovascular events was found after discharge from hospital in intensive group （P〈0.01）. Conclusion Intensive lipid-lowering therapy with atorvastatin in NSTE-ACS patients who did not receive reascularization treatment can obviously improve the clinical symptoms, reduce the complications and serious cardiovascular events.And a large dose of atorvastatin can gain greater benefits and is also safety.