急性冠状动脉综合征患者采用短期强化他汀治疗的效果及安全性分析

Efficacy and safety of short-term intensive statin therapy in patients with acute coronary syndrome

目的探讨短期强化他汀在急性冠状动脉（冠脉）综合征患者治疗中的临床疗效及安全性。方法人组2013年3月至7月本院就诊的急性冠脉综合征患者共218例，按单双号随机人组法分为强化组（107例）与常规组（111例）：强化组入院及住院期间均予阿托伐他汀80mg／晚，出院后予阿托伐他汀40mg／晚；常规组入院及住院期间均予阿托伐他汀20mg／晚，出院后予阿托伐他汀20mg／晚。于入院时及出院后1个月检测两组患者相关生化指标并进行比较。结果强化组治疗1个月后，其TC、TG、LDL—C等均较前显著下降[分别为（1．52±0．88）比（0．75±0．14）mmol／L，P〈0．05；（4．55±1．12）比（2．21±0．78）mmol／L，P〈0．05；（2．23±0．77）比（1．76±0．31）mmol／L，P〈0．05]；而HDL．C升高明显[（1．15±0．34）比（1．52±0．41）mmol／L，P〈0．05]。与常规组相比，强化组1个月后其肝酶及肌酸激酶等无明显增加，肌酐水平较治疗前有所下降[（82．53±23．85）比（57．81±15．27）μmol／L，P〈0．05]；同时患者的血同型半胱氨酸及超敏CRP水平较前下降[分别为（30．70±18．82）比（10．52±4．66）mmo]／L，P〈0．05；（19．75±11．91）比（8．06±2．68）mg／L，P〈0．05]。结论短期强化他汀治疗在保证用药安全的前提下，能快速有效地降低患者的TC、TG、LDL—C及同型半胱氨酸水平，提高HDL—C，并有一定的抗炎、肾功能保护作用，患者临床获益大。

Objective To evaluate the clinical efficacy and safety of short-term intensive statin therapy in patients with acute coronary syndrome （ACS）. Methods A total of 218 ACS patients admitted in Hangzhou First People＇s Hospital from March 2013 to July 2013 were enrolled into this study. The patients were randomly assigned to receive atorvastatin 80 mg/d during hospitalization, and 40 mg/night after discharge for one month （intensive group, n = 107 ） ; or receive atorvastin 20 mg during hospitalization and 20 mg/night after discharge for one month （ control group, n = 111 ） . The biochemical indexes were measured on the admission and after one-month treatment. Results After one-month treatment, the total cholesterol, triglycerides and LDL cholesterol of intensive group were significantly lower, and the high density lipoprotein cholesterol was higher than baseline values （ 0. 75 ± 0. 14 ） mmot/L vs. （ 1.52 ± 0. 88 ） mmol/L, P〈0.05;（2.21 ±0. 78）mmol/L vs. （4.55 ± 1.12） mmol/L, P 〈0.05;（1.76 ±0. 31 ） mmol/L vs. （2.23 ±0.77） mmol/L, P〈0.05; （1.15 ±0.34） vs. （1. 52 ± 0. 41） mmol/L, P〈0.05. The liver enzymes creatine kinase in intensive group was not significantly changed, but the creatinine levels decreased （82. 53 ±23.85） μmoL/L vs. （57.81 ± 15.27） μmol/L, P 〈0. 05, and the blood homoeysteine and ultra- sensitivity C-reactive protein levels also decreased compared with the baseline （ 10. 52 ± 4. 66 ） mmol/L vs. （30.70 ± 18.82） mmol/L, P 〈 0.05; （8.06 ± 2.68） mg/L vs. （19.75 ± 11.91 ） mg/L, P 〈 0.05. Conclusions Short-term intensive statin therapy can effectively reduce blood lipid, cholesterol and homocysteine levels and raise HDL cholesterol levels; also with its anti-inflammatory and renal protectiveeffect the therapy can provide more clinical benefit for patients with ACS.