冠心病合并高脂血症患者血脂治疗达标分析

Lipid Goal Attainment Among Coronary Heart Disease Patients with Dyslipidemia

目的了解冠心病合并高脂血症患者临床干预的达标情况。方法利用电子病例管理系统回顾性检索2010年4月、5月首次住院的冠心病合并高脂血症患者115例,比较首次住院期间和随访期间血清总胆固醇、甘油三酯、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、谷丙转氨酶、谷草转氨酶等指标水平的变化,同时观察随访期间不良事件。结果高危患者首次住院期间血清总胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇达标率分别为22.1%、50%、35.3%;随访期间血清总胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇达标率分别为57.4%、70.6%、70.6%。随访期间高密度脂蛋白胆固醇和非高密度脂蛋白胆固醇达标率均较住院期间有升高(P=0.024,P<0.001)。极高危患者首次住院期间血清总胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇达标率分别为2.1%、19.1%、8.5%。随访期间血清总胆固醇、低密度脂蛋白胆固醇、非高密度脂蛋白胆固醇达标率分别为10.6%、46.8%、44.7%。高危患者的血清总胆固醇及低密度脂蛋白胆固醇达标率均高于极高危患者(均P<0.001)。肌痛发生率低,未见明显肝肾功能损害和横纹肌溶解,不良事件发生率低。结论冠心病患者血脂干预与达标仍有距离,临床要重视高危和极高危患者的强化血脂治疗和达标。

Aim To learn about the lipid goal attainment among coronary heart disease patients with dyslipidemia. Methods We retrospectively summarized 115 patients of coronary heart disease with dyslipidemia from April to May 2010 by electrical case management system in Fuwai Hospital. These patients, who had hyperlipaemia course no shorter than half a year, all charged first time and successfully followed up over half a year. During the first hospitalization and the follow up, the value changes of serum total cholesterol （TC ）, triglyceride （TG ）, low density lipoprotein cholesterol （LDLC ）, high density lipoprotein cholesterol （HDLC ）, aspartate aminotransferase （AST）, alanine aminotransferase （ALT） and et al were compared. In addition, the adverse event was also observed at the same time. Results The target rates of TC, LDLC and non-HDL in the high-risk group were 22. 1%, 50% and 35.3% during the first hospital- ization, and were 57.4%, 70.6% and 70. 6% during follow-up, respectively. The target rates of HDL and non-HDL during the follow-up were both superior to that during the first hospitalization （ P = 0. 024, P 〈 0. 001 ）. For the highest- risk patients, the target rates of TC, LDLC and non-HDL were 2. 1%, 19. 1% and 8.5% during the first hospitalization, and were 10. 6%, 46. 8%, and 44. 7% during follow-up, respectively. Compared with highest-risk patients, the TC and LDLC target rates of high-risk patients were both better （ all P 〈 0. 001 ）. Conclusion There was still gap between lipid drug therapy and goal attainment. More attention should be payed to the risk stratification of dyslipidemia to strengthen the lipid treatment in clinical work.