不同强度他汀对中青年冠心病患者支架植入术后血脂水平的影响及安全性

Effect of different doses of statins on blood lipid levels and safety of young and middle-aged coronary heart disease patients after coronary stent implantation

目的：探讨不同强度他汀对中青年冠心病支架植入术后患者血脂水平的影响及安全性。方法：回顾性分析我科2013年12月至2014年6月住院治疗的中青年冠心病支架植入术后服用瑞舒伐他汀（可定）的168例患者的相关情况,其中应用瑞舒伐他汀10 mg/d治疗的81例（中强度组）,应用瑞舒伐他汀20mg/d治疗的87例（高强度组）,治疗6~8周后,比较两组患者治疗前后总胆固醇（total cholesterol,TC）、甘油三酯（triglyceride,TG）、低密度脂蛋白（low density lipoprotein cholesterol,LDL-C）、高密度脂蛋白（high density lipoprotein cholesterol,HDL-C）以及谷丙转氨酶（alanine transaminase,ALT）、谷草转氨酶（aspartate transaminase,AST）、超敏C反应蛋白（hypersensitive3 C-reactive protein,hs-CRP）、肌酸肌酶（creatine kinase,CK）的变化水平和不良反应。结果：治疗6~8周后,2组患者的TC、TG、LDL-C及hs-CRP均较治疗前明显下降（高强度组：5.42±1.09、2.85±0.71,P=0.000;1.69±0.73、1.14±0.31,P=0.000;3.56±0.95、1.79±0.54,P=0.000;2.64±1.22、1.04±0.63,P=0.000;中强度组：5.31±1.29、3.18±0.85,P=0.000;1.63±0.58、1.22±0.25,P=0.000;3.39±0.66、2.00±0.76,P=0.000;2.42±1.40、1.33±0.68,P=0.000）,HDL-C较治疗前升高（高强度组：1.23±0.29、1.42±0.30,P=0.000;中强度组：1.19±0.35、1.37±0.42,P=0.003）。高强度治疗组的TC、LDL-C及hs-CRP下降较中强度组明显（2.85±0.71、3.18±0.85,P=0.006;1.79±0.54、2.00±0.76,P=0.036;1.04±0.63、1.33±0.68,P=0.005）。治疗期间所有患者均未发生转氨酶及肌酶异常。结论：高强度他汀（瑞舒伐他汀20 mg/d）较中强度他汀（瑞舒伐他汀10 mg/d）降低LDL-C的效果更佳,且安全性较好。

Objective：To investigate the effect of different doses of statins on blood lipid levels and safety of young and middle-aged coronary heart disease patients after coronary stent implantation. Methods：Retrospective analysis on the young and middle-aged patients who had coronary stent implantation in our department from December 2013 to June 2014 was conducted. Totally 81 patients received rosuvastatin at the dose of 10 mg/d and 87 received rosuvastatin at the dose of 20 mg/d. After the treatment of 6 to 8 weeks,the changes of levels of total cholesterol（TC）,triglyceride（TG）,low density lipoprotein cholesterol（LDL-C）,high density lipoprotein cholesterol（HDL-C）,alanine transaminase（ALT）,aspartate transaminase（AST）,hypersensitive3 C-reactive protein（hs-CRP）,Creatine Kinase（CK）and adverse reaction rate were compared between the two groups before and after treatment. Results：After the treatment of 6 to 8 weeks,significant declines were found in the levels of TC,TG,LDL-C,hs-CRP both in the two groups. HDL-C was significantly higher after the treatment. The changes in the levels of TC LDL-C and hs-CRP in high-intensity rosuvastatin group were significantly higher than those of moderate-intensity rosuvastatin group,with statistical significances. No patient experienced the abnormal transaminase and abnormal muscle enzymes. Conclusion：For the young and middle-aged patients after coronary stent implantation,high-intensity statin（20 mg rosuvastatin）is more effective and safe than moderate-intensity statin（10 mg rosuvastatin）,and has good safety.