早期他汀序贯治疗在行经皮冠状动脉介入治疗冠心病患者中的临床应用

Early atorvastatin sequential therapy in coronary heart disease patients after percutaneous coronary intervention

目的评价冠心病行经皮冠状动脉介入治疗（PCI）患者中早期应用阿托伐他汀序贯治疗方法的安全性和有效性。方法170例冠心病患者随机分为序贯治疗组和常规治疗组，每组85例。比较两组基线资料，随访观察治疗前后1周、1个月、3个月、6个月的总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、肝功能、肾功能、肌酸激酶（CK）、超敏C反应蛋白（hsCRP）等生化指标的变化以及不良事件和不良反应的发生情况。结果两组治疗后LDL-C和TC的水平较治疗前均有显著下降（P〈0．05）。两组1周时LDL-C和TC的下降幅度差异有统计学意义（LDL-C：31．2％vs12．5％；TC：29．2％vs13．1％；P〈0．05），1个月时在原有基础上进一步降低，两组差异有统计学意义（LDL-C：43．0％vs17．6％；TC：41．3％vs22．3％：P〈0．05）。3个月和6个月时，两组间LDL-C和TC变化无统计学差异（P〉0．05）。序贯治疗组1周、1个月、3个月时LDL-C的达标率明显高于常规治疗组（1周：48．2％ vs 25．9％；1个月：77．6％vs60．0％；3个月：81．2％vs68．2％；P〈0．05）。与治疗前相比，两组均可显著降低hs-CRP的水平，序贯治疗组1周和1个月时hs-CRP降低幅度明显大于常规治疗组f序贯治疗组治疗前（8．17±5．69）mg／L，1周时（4．23±2．43）mg／L，1个月时（1．96±0．77）mg／L；常规治疗组治疗前（7．75±4．31）mg／L，1周时（4．87±2．70）mg／L，1个月时（3．21±1．27）mg／L；P＜0．05]。序贯治疗组6个月内主要心血管事件发生率明显低于常规治疗组（5．9％vs15．3％，P〈0．05），序贯治疗组比常规治疗组风险进一步降低了9．4％。序贯治疗组不良反应轻微，两组不良反应发生率差异无统计学意义（P〉0．05）。结论他汀序贯治疗的疗效和安全性良好，可以明显改善冠心病PCI术患者的临床预后。

Objective To evaluate the safety and effectiveness of early atorvastatin sequential therapy in coronary heart disease （CHD） patients after percutaneous coronary intervention （PCI）. Methods A total of 170 CHD patients ready to receive PCI were randomly divided into sequential dose group （group A： atorvastatin 80mg as loading dose, then 40mg/d for 1 month and 20mg/d subsequently, n=85） and ordinary dose group （group B： atorvastatin 20mg/d, n=85）.Laboratory records, such as blood Lipid, hepatic function, renal function, creatine kinase （CK）, hypersensitive Creactive protein （CRP） were observed at different time points including 1 week, 1 month, 3 months and 6 months. Main adverse cardiac events and adverse effects were also analyzed. Results Compared with baseline, the level of low-density lipoprotein-cholesterol （LDL-C） and total cholesterol （TC） was significantly decreased at each time points in both two groups（P 〈 0.05）. The decreasing degree of LDL-C and TC level at 1 week had significant differences between two groups（LDL-C：31.2% vs 12.5%;TC：29.2% vs 13.1%;P〈 0.05）; meanwhile, the decreasing degree was keeping enlarged at 1 month between two groups（LDL-C： 43.0% vs 17.6%;TC： 41.3% vs 22.3%;P 〈 0.05）. The change in LDL-C and TC level was not significantly different between the two groups at 3 and 6 months （P 〉 0.05）. The rate that LDL-C met predefined standard in group A was significantly higher than that in group B at 1 week, 1 month and 3 months respectively. The hsCRP level was significantly decreased in both groups, which was more significant in group A than in group B at 1 week and 1 month[group A： （8.17 ± 5.69）mg/L at pretreatment, （4.23±2.43）mg/L at 1 week, and （1.96 ±0.77）mg/L at 1 month respectively; groupB： （7.75 ± 4.31）mg/L at pretreatment, （4.87 ± 2.70）mg/L at 1 week, and （3.21± 1.27）mg/L at 1 month respectively; P 〈 0.05]. Incidence of main adversecardiac events was significantly lower in group A than in group B at 6 months （5.9% vs15.3%, P 〈 0.05）, which further decreased by 9.4% in group A. The adverse effects were very trivial and had no significant difference between two groups （P 〉 0.05）. Conelusion The atorvastatin sequential therapy early used in CHD patients after PCI is superior to ordinary atorvastatin therapy in efficacy, which shows better clinical prognosis without increase of adverse effects.