以非高密度脂蛋白胆固醇为靶标的联合降脂药物治疗急性冠脉综合征患者的疗效

Effect of combination lipid-lowering therapy for patients with acute coronary syndrome targeting at nonhigh-density lipoprotein cholesterol

目的以血清非高密度脂蛋白胆固醇(non-high-density lipoprotein cholesterol,non-HDL-C)浓度为靶标,探讨阿托伐他汀和非诺贝特联合用药在急性冠脉综合征患者中的疗效和安全性。方法选取200例急性冠脉综合征患者,网络随机分为他汀降脂组(n=100,阿托伐他汀20 mg/d)和联合降脂组(n=100,阿托伐他汀20 mg/d+非诺贝特250 mg/d),分别于治疗前及治疗后3个月、12个月、24个月检测两组血清血脂浓度和高敏C反应蛋白(high-sensitivity C reaction protein,hs-CRP)浓度,计算non-HDL-C变化率及达标率,并记录两组患者主要心血管事件发生情况。结果联合降脂组血脂和hs-CRP浓度降低幅度明显优于他汀降脂组;达标率、斑块消退率、血清C反应蛋白浓度<2 mg/L率明显高于对照组,差异有统计学意义(P<0.05)。在预防非致死性心肌梗死、再次血运重建、缺血性卒中、不稳定型心绞痛的事件发生上,联合降脂组明显优于他汀降脂组,差异有统计学意义(P<0.05)。但两组全因病死率、心脏性死亡事件发生率比较,差异无统计学意义(P>0.05)。结论对急性冠脉综合征患者予以阿托伐他汀联合非诺贝特的降脂治疗较单药治疗效果更显著,具有良好的耐受性和安全性。

Objectives To investigate the efficacy and safety of combination lipid-lowering therapy with atorvastatin and fenofibrate for patients with acute coronary syndrome （ACS） targeting at non-high-density lipoprotein cholesterol （non-HDL-C）.Methods Totally 200 patients with ACS were randomly divided into two groups：single medication group（n=100,atorvastatin 20 mg/d） and combination medication group （n=100,atorvastatin 20 mg/d ＋ fenofibrate 250 mg/d）.Before treatment,concentrations of blood lipids and high-sensitivity C-reaction protein （hs-CRP） were recorded.They were re-examined in 3 months,12 months and 24 months after treatment.Change and compliance rate of non-HDL-C and major adverse cardiovascular events were assessed.Results Combination therapy was much more effective in normalizing lipid profile and hs-CRP concentration than single medication （P〈0.05）.Compliance rate,plaque regression rate and Creaction protein〈2 mg/L rate in combination therapy group were much higher than those in single medication group （P〈0.05）.In prevention of incidence of non-fatal myocardial infarction,repeat revascularization,ischemic stroke and unstable angina,combination therapy was significantly better than single medication therapy（P〈0.05）.But rates of all-cause mortality and cardiac death were not significantly different between the two groups（P〉0.05）.Conclusions Combination therapy with atorvastatin and fenofibrate for patients with ACS is more effective than single medication.It is safe and well tolerated.