冠状动脉粥样硬化性心脏病235例降脂治疗现状分析

Current status of lipid-lowering therapy in 235 patients with coronary heart disease

目的了解冠状动脉粥样硬化性心脏病(冠心病)患者目前降脂治疗和达标的情况,并分析可能影响治疗达标的因素。方法选取深圳市第四(福田)医院2010年6月至2012年3月确诊冠心病的患者235例为研究对象。获取初始血脂水平以及在院期间接受降脂治疗的情况,通过电话、信函结合门诊复查形式进行随访,填答冠心病治疗调查问卷,记录结果并进行分析总结。结果 (1)住院期间冠心病患者降脂治疗率为90.2%;(2)随访期间降脂治疗率为68.9%,低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)<1.8 mmol/L和(或)减少≥50%,即降脂达标[2011年欧洲心脏病协会/欧洲动脉硬化协会]患者仅占35.7%;(3)所有接受降脂治疗的冠心病患者,谷丙转氨酶、肌酸激酶与血肌酐浓度无显著升高,且与初始值比较,差异无统计学意义(P<0.05)。结论冠心病降脂治疗仍存在很大治疗间隙和不少认识误区;达标与否受到医疗质量、患者依从性、药效、社会经济等多种因素的影响;降脂药物的选择和剂量恰当时,长期治疗是安全的。

Objectives To investigate plasma lipid level, ratio of achieving the optimal goals and possible influence factors in patients with coronary heart disease （CHD）. Methods Totally 235 patients diagnosed as CHD from June 2010 to March 2012 in The Forth People＇s Hospital of Shenzhen were enrolled in this study. Incipient plasma lipid level, medications and status of therapy of the patients who were followed up after discharge were observed and analyzed. Results （ 1 ） 90.2% of the CHD patients took lipid-lowering drugs in hospital. （2） Lipid-lowering therapy was used in 68.9% of patients during the following-up period. According to Europe Society of Cardiology^European Athemsclerosis Society （ESC/EAS） guidelines, ratio of achieving the optimal low-density lipoprotein cholesterol （LDL-C） goals （ LDL- C〈 1.8 mmoL and/or decreases ≥ 50%） was 35.7%. （3） None of the patients had apparent elevated alanine aminotransferase, creatine kinase and serum creatinine, and they had no significant differences with those of incipient values （P〉0.05）. Conclusions The current status of CHD lipid-lowering therapy and the benefit for patients remain far from ideal, and there remains a treatment gap. The ratio of achieving the optimal goals is influenced by the quality of care, patient compliance, drug efficacy, cost-benefit and so on. Long-term lipid-lowering therapy is safe when the drug use and dose are appropriate.