缺血性脑卒中患者阿托伐他汀降脂达标及安全性影响因素分析

Influence factors analysis on lipid-lowering effect and safety of atorvastatin on serum lipids in patients with ischemic stroke

目的观察不同剂量阿托伐他汀对缺血性脑卒中患者的降脂疗效和安全性以及其影响因素。方法共入选204例脑卒中患者,分为A、B、C三组分别给予阿托伐他汀10 mg/d、20 mg/d及40 mg/d,观察其降脂效果及安全性;并采用多因素回归分析的方法,观察年龄、性别、吸烟、饮酒、服药抗血小板聚集药物、降脂药剂量、高血压、糖尿病、体质指数等对阿托伐他汀降脂达标及安全性的影响。结果治疗前,A组低密度脂蛋白(LDL-C)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL)分别为(2.72±0.39)mmol/L、(4.81±0.61)mmol/L、(1.75±0.62)mmol/L、(1.17±0.30)mmol/L,B组分别为(3.87±0.76)mmol/L、(6.00±1.00)mmol/L、(2.04±0.88)mmol/L、(1.27±0.25)mmol/L,C组分别为(5.63±2.21)mmol/L、(7.39±2.50)mmol/L、(2.13±1.14)mmol/L、(1.35±0.48)mmol/L;治疗后A组LDL-C、TC、TG、HDL分别为(2.52±0.34)mmol/L、(3.81±0.61)mmol/L、(1.59±0.57)mmol/L、(1.21±0.32)mmol/L,B组分别为(2.57±0.54)mmol/L、(4.61±0.95)mmol/L、(1.79±0.58)mmol/L、(1.34±0.28)mmol/L,C组分别为(2.65±1.00)mmol/L、(5.24±1.49)mmol/L、(1.85±0.91)mmol/L、(1.52±0.45)mmol/L。相比较治疗前,三组治疗后LDL-C、TC、TG均有显著性降低。HDL在A组治疗前后无显著性差异,B、C两组均显著性升高。组间比较显示C组降低LDL-C及升高HDL最明显。三组患者对药物均有良好的耐受性,均没有出现需要干预的肝功能异常及CK异常。统计学分析发现,饮酒可以增加阿托伐他汀致转氨酶增高。结论阿托伐他汀具有良好的降脂作用,且安全性良好,20 mg、40 mg效果更佳。饮酒增加阿托伐他汀引起肝损害。

Objective To observe lipid-lowering effect and safety of different doses of atorvastatin in patients with ischemic stroke, and its influence factors. Methods 204 patients with ischemic stroke were administrated and divided into A, B and C groups with atorvastatin 10 mg, 20 mg, 40 mg daily separately for 8 weeks, Therapeutic effects and safety were observed. The effects of age, gender, smoking, drinking, anti-platelet aggregation drugs, lipid-lowering drugs dose, hypertension, diabetes mellitus, body mass index（BMI）were analyzed with multiple factors regression analysis. Results Before treatment, the levels of low density lipoprotein cholesterol（LDL-C）, total cholesterol（TC）, triglyceride（TG）, high-density lipoprotein（HDL）were（2.72 ± 0.39）mmol/L, （4.81±0.61）mmol/L, （1.75±0.62）mmol/L, （1.17±0.30）mmol/L in group A, （3.87±0.76）mmol/L, （6.00±1.00）mmol/L, （2.04±0.88）mmol/L, （1.27±0.25）mmol/L in group B, and （5.63±2.21）mmol/L, （7.39± 2.50）mmol/L, （2.13±1.14）mmol/L, （1.35±0.48）mmol/L in group C. After treatment, the levels of LDL-C, TC, TG and HDL were （2.52±0.34）mmol/L, （3.81±0.61）mmol/L, （1.59±0.57）mmol/L, （1.21±0.32）mmol/L in group A, （2.57±0.54）mmol/L, （4.61±0.95）mmol/L, （1.79±0.58）mmol/L, （1.34±0.28）mmol/L in group B, and （2.65±1.00）mmol/L, （5.24±1.49）mmol/L, （1.85±0.91）mmol/L, （1.52±0.45）mmol/L in group C. Compared with before treatment, the level of LDL-C,TC,TG significantly decreased in three groups after treatment. The level of HDL was no significant change in group A, but increased significant in group B and group C. The depth of LDL-C decreasing and HDL increasing in group C was most significant in three groups. There is no liver dysfunction and CK dysfunction to need interventions. By statistical analysis, drinking can increase transaminase in patients taking atorvastatin. Conclusion Atorvastatin with good lipid-lowering effect has favorable safety, effect of 20 mg and 40 mg is better. Drinking increases atorvastatin causing liver damage.