阿西莫司联合小剂量阿托伐他汀治疗肾移植术后混合型高脂血症的疗效与安全性

Therapeutic effect and safety of acipimox combined with small-dose atorvastatin on combined hyperlipidemia after renal transplantation

目的：评价阿西莫司联合小剂量阿托伐他汀治疗肾移植术后混合型高脂血症的疗效及安全性。方法56例肾移植术后合并混合型高脂血症的患者，随机分为联合小剂量组[28例，阿西莫司（250 mg，每日2次）＋阿托伐他汀（10 mg，每日1次）]和正常剂量组[28例，阿托伐他汀（20～40 mg，每日1次）]。比较治疗前及治疗后1、2、3个月血清中总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）、血清肌酐（Scr）、血尿素氮（BUN）、尿酸（UA）、肌酸激酶（CK）等指标，并记录药物不良反应。结果与治疗前比较，正常剂量组与联合小剂量组在治疗后 TC、TG 、LDL-C均下降，HDL-C 轻度升高，差异均有统计学意义（均为 P ＜0.01）。与正常剂量组比较，联合小剂量组的 TG 、LDL-C 均较低，HDL-C 较高，差异均有统计学意义（均为 P ＜0.01）。在治疗前和治疗后各时间点，正常剂量组与联合小剂量组的 ALT、AST、Scr、BUN、UA、CK 比较，差异均无统计学意义（均为 P ＞0.05）。正常剂量组和联合小剂量组的消化系统、神经系统、骨骼肌肉系统、皮肤血管的不良反应发生率比较差异均有统计学意义（均为 P ＜0.05）。结论阿西莫司联合小剂量阿托伐他汀能安全有效地治疗肾移植术后混合型高脂血症。

Objective To assess the therapeutic effect and safety of acipimox combined with small-dose atorvastatin on combined hyperlipidemia after renal transplantation. Methods Fifty-six patients complicated with combined hyperlipidemia after renal transplantation were randomized into the combined small-dose group [n =28,acipimox （250 mg,twice a day） ＋atorvastatin （1 0 mg,once a day）]and normal dose group [n =28,atorvastatin （20-40 mg,once a day）].Total cholesterol （TC）,triglyceride （TG）,high density lipoprotein cholesterin （HDL-C ）, low density lipoprotein cholesterin （LDL-C ）, aspartate aminotransaminase （AST）,alanine aminotransferase （ALT）,serum creatinine （Scr）,blood urea nitrogen （BUN）,uric acid （UA）and creatine kinase （CK）were observed before treatment and 1 ,2 and 3 months after treatment.Adverse drug reaction was recorded.Results Compared with those before treatment,TC,TG and LDL-C of the normal dose group and the combined small-dose group decreased after treatment,but HDL-C increased,and the difference had statistical significance （all in P 〈0.01 ）.Compared with the normal dose group,TG and LDL-C of the combined small-dose group were lower and HDL-C was higher,and the difference had statistical significance （all in P 〈0.01 ）.At each time point before and after treatment,ALT,AST,Scr, BUN,UA and CK of the normal dose group and the combined small-dose group showed no statistically significant difference （all in P 〉0.05）.There was significant difference in the incidence of adverse reactions in the digestive system,nervous system,musculoskeletal system and skin/vascular of the normal dose group and the combined small-dose group （all in P 〈0.05 ）.Conclusions Acipimox combined with small-dose atorvastatin can treat combined hyperlipidemia after renal transplantation safely and effectively.