瑞舒伐他汀联合依折麦布治疗冠心病合并慢性肾功能不全的临床观察

Effectiveness of rosuvastatin combined with ezetimibe on coronary heart disease complicated with chronic renal insufficiency

目的对比观察冠心病合并慢性肾功能不全患者单用瑞舒伐他汀以及瑞舒伐他汀联合依折麦布治疗时血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、估算肾小球滤过率(e GRF)、24h尿白蛋白排泄率(UAER)水平的变化,探讨联合用药改善患者冠心病症状、改善肾功能的疗效及安全性。方法 2012年12月至2013年6月连续入选120例冠心病合并慢性肾功能不全的患者,随机分为治疗组(每晚口服瑞舒伐他汀10mg和依折麦布10mg)和对照组(每晚口服瑞舒伐他汀10mg),服药16周后比较治疗前后TC、LDL-C、e GRF、UAER的变化。结果两组治疗16周与治疗前比较,TC、LDL-C、UAER明显降低,e GRF明显升高,差异有统计学意义(P<0.05);治疗组TC、LDL-C、UAER较对照组降低更明显,e GRF升高更明显,心绞痛发作次数明显减少,两组间比较差异有统计学意义(P<0.05);治疗期间两组均有转氨酶升高者,但未超过标准值3倍,未应用保肝药物,经复查自行恢复正常。结论冠心病合并慢性肾功能不全患者应用瑞舒伐他汀联用依折麦布有更好的改善心绞痛症状及保护肾功能的作用,且毒副反应少,安全性好。

Objective Aim To compare effectiveness of rosuvastatin only and rosuvastatin combined with ezetimibe on modifying total cholesterol （ TC）, low density lipoprotein cholesterol （ LDL - C）, estimated glomerular filtration rate （eGRF）, 24h urinary albumin excretion rate （UAER） levels ,and the safety to improve symptoms and kidney function in coronary heart disease patients. Methods 2012 December to 2013 June a total of 120 coronary artery disease complicated with chronic renal insufficiency patients, randomly divided into treatment group （oral 10mg night rosuvastatin and ezetimibe 10mg） and control group （each night oral rosuvastatin 10mg）. TC, LDL - C, eGRF, UAER were measured after 16 weeks of treatment. Results Two groups were treated for 16 weeks compared with before treatment, TC, LDL - C, UAER decreased significantly, eGRF increased significantly, the difference was statistically significant （ P 〈 0. 05 ） The treatment group TC, LDL - C, UAER than the control group decreased more significantly, eGRF increased obviously, the frequency of angina was significantly reduced, there was significant difference between two groups （ P 〈 0.05 ）. During the treatment two groups were elevated transaminase, but not more than 3 times the standard value, without the use of protective drug, after review, recovery. Conclusion Coronary heart disease and chronic renal insufficiency patients with rosuvastatin combined with ezetimibe has better improvement in symptoms of angina pectoris and protection of renal function, and less toxicity, and good safety.