两种剂量瑞舒伐他汀治疗急性心肌梗死的疗效比较

Rosuvastatin therapy for patients with acute myocardial infarction

目的：探讨不同剂量瑞舒伐他汀治疗急性心肌梗死（AMI）患者的降脂疗效和安全性的评价。方法：选取在我院冠心病重症监护室2012年1月～9月的232例AMI患者，分成强化治疗（强化组）和普通剂量组（常规组），强化组：178例，瑞舒伐他汀20mg／d；常规组：54例，瑞舒伐他汀10mg／d。对出院时丙氨酸转移酶（ALT）和（或）门冬氨酸转移酶（AST）升高超过正常值3倍以上的患者服用剂量减半或停用，即强化组患者瑞舒伐他汀10mg／d，常规组患者暂时停用瑞舒伐他汀。比较入院时、出院时及随访1个月、3个月的血脂指标、超敏C反应蛋白（hs—CRP）、肝肾功能变化及主要心血管事件的发生情况。结果：①两组的总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）、载脂蛋白B（ApoB）均有显著下降（P〈0．05），其中强化组在出院1个月时降低LDL—C的水平更显著（P〈0．05）。②两组患者的hs—CRP出院后均有显著下降，但两组问比较差异无统计学意义。③出院后患者返院复查肝肾功能，两组比较差异无统计学意义。④对主要心血管事件进行3个月随访，强化组无患者死亡，常规组3例死亡，两组比较差异有统计学意义（P〈0．05）。结论：AMI患者早期应用瑞舒伐他汀强化治疗更有效、更安全。

AIM ： To assess the safety and the lipid-lowering efficacy of different doses of rosuvastatin in patients with acute myocardial infarction （AMI）. METHODS： A total of 232 AMI patients admitted to our hospital from January 2012 to September were divided into intensive treatment group （group A, n = 178, rosuvastatin 20 rag/day） and the common dose group （group B, n = 54, rosuvastatin 10 rag/day）. Patients in group A with increased liver enzyme level （three times higher than normal） at discharge took rosuvastatin 10 mg daily and patients in group B under the same conditions stopped taking rosuvastatin. Lipid profiles, high-sensitivity C-reactive protein, liver and kidney function, and major cardiovascular events were compared at admission, discharge, 1 month and 3 months after discharge. RESULTS： Total cholesterol （ TC ）, LDL-C, apolipoprotein B （apoB） in both groups significantly decreased （ P 〈 0.05 ） and LDL-C level was more significantly decreased 1 month after discharge in group A （P 〈 0. 05 ）. Hs-CRP significantly decreased after discharge, with no statistical difference between groups. After discharge, no statistical difference was found in liver and kidney functions between groups. Three-month follow-up showed statistical differences in major cardiovascular events between group A and group B （ death, 0 vs. 3, P 〈 0.05）. CONCLUSION ： Intensive rosuvastatin therapy is safe and more effective for patients with AMI.