多廿烷醇在老年心血管病患者调脂治疗中的有效性及安全性分析

Efficacy and safety of policosanol in lipid-regulating therapy for elderly cardiovascular disease patients

目的探讨多廿烷醇在老年心血管病患者调脂作用中的有效性及安全性。方法选择老年血脂异常患者289例,根据服用药物情况分为4组。A组64例:多廿烷醇20mg;B组72例:多廿烷醇10mg;C组91例:阿托伐他汀20mg;D组62例:多廿烷醇10mg+阿托伐他汀20mg。所有患者分别于试验前、试验12、24、52周检测TC、TG、LDL-C、HDL-C、脂蛋白(a)、载脂蛋白(apo)A-Ⅰ、apoB、丙氨酸转氨酶、天冬氨酸转氨酶、肌酸激酶等。结果与试验前比较,A组、B组、C组、D组试验后12周LDL-C[(2.28±0.49)mmol/L vs(2.74±0.54)mmol/L,(2.43±0.62)mmol/L vs(2.67±0.53)mmol/L,(2.19±0.69)mmol/L vs(2.69±0.57)mmol/L,(2.12±0.57)mmol/L vs(2.71±0.62)mmol/L]、TC[(5.21±0.23)mmol/L vs(5.62±0.45)mmol/L,(5.34±0.47)mmol/L vs(5.58±0.32)mmol/L,(5.15±0.32)mmol/L vs(5.60±0.41)mmol/L,(5.01±0.46)mmol/L vs(5.69±0.39)mmol/L]、脂蛋白(a)、apoB、apoB/apoA-Ⅰ明显降低,其中24、52周LDL-C、TC、脂蛋白(a)、apoB较12周明显降低,52周LDL-C、TC、apoB较24周明显降低(P<0.05)。整个试验过程中,各组均未出现显著骨骼肌疼痛、肌溶解等严重不良反应,但在C组及D组患者中分别出现4例及3例肝脏转氨酶上升超过正常值3倍的病例,停药后,肝功能逐渐恢复至正常。结论多廿烷醇可发挥有效血脂调节作用,小剂量多廿烷醇联合常规剂量阿托伐他汀可进一步增强调脂作用。老年人应用10、20mg多廿烷醇及联合常规剂量的阿托伐他汀都具有良好安全性。

Objective To study the efficacy and safety of policosanol in lipid-regulating therapy for elderly cardiovascular disease patients.Methods Two hundred and eighty-nine elderly dyslipidemia patients were divided into group A（n=64）treated with 20 mg policosanol,group B（n=72）treated with 10 mg policosanol,group C（n=91）treated with 20 mg atorvastatin in,and group D（n=62）treated with 10 mg policosanol＋20 mg atorvastatin.Their serum levels of TC,TG,LDL-C,HDL-C,Lp（a）,apoA-Ⅰ,apoB,ALT,AST and CK were measured before and at weeks12,24,52 after lipid testing.Results The serum levels of LDL-C,TC,Lp（a）,apoB were significantly lower at weeks 12 after lipid testing than before lipid testing,at weeks 24 and 52than at week 12,and at week 52 than at week 24 after lipid testing（P〈0.05）.No severe skeletal muscle pain and myolysis occurred.However,the serum transaminase level was 3-fold higher in 4patients of group C and in 3patients of group D,which gradually returned to its normal after treatment.Conclusion Policosanol plays an effective role in regulating blood lipid.A small dose of policosanol combined with a routine dose of atorvastatin can further decrease blood lipid.The safety of10 mg and 20 mg policosanol combined with a routine dose of atorvastatin is rather high in elderly patients.