对他汀类药物反应不同者治疗前后血脂和胆固醇代谢标志物变化及其相关性

Changes of Blood Lipid and Cholesterol Metabolism Markers and Their Correlation Before and After Treatment in Subjects with Different Responses to Statins

目的探讨阿托伐他汀治疗前后冠心病高危人群血脂和胆固醇代谢标志物(胆固醇合成、吸收标志物)的变化,并分析其相关性。方法分别测定159例冠心病高危人群在口服20 mg阿托伐他汀4周前后血脂及胆固醇合成标志物[角鲨烯/总胆固醇(TC)、链甾醇/TC、7-烯胆烷醇/TC]、吸收标志物(谷固醇/TC、豆固醇/TC、菜油固醇/TC)。根据阿托伐他汀治疗后低密度脂蛋白胆固醇(LDLC)水平,将入选者分为反应好者和反应差者两组。分析两组血脂和胆固醇代谢标志物的变化情况及相关性。结果阿托伐他汀治疗后两组的血脂,除高密度脂蛋白胆固醇升高(反应好者9.4%,反应差者7.4%)外,其它几项均降低,反应好者TC、LDLC下降幅度较反应差者更大(均P<0.01)。反应好者中,TC降低幅度与角鲨烯/TC、谷固醇/TC降低幅度呈正相关(r=0.247,r=0.205,均P<0.05),LDLC降低幅度与菜油固醇/TC降低幅度呈正相关(r=0.193,P<0.05);反应差者中,TC降低幅度与豆固醇/TC降低幅度呈负相关(r=-0.388,P<0.01),LDLC降低幅度与角鲨烯/TC、豆固醇/TC、谷固醇/TC降低幅度呈负相关(r=-0.280,P<0.05;r=-0.517,P<0.01;r=-0.320,P<0.05)。结论阿托伐他汀治疗后,TC、LDLC的变化在反应好者中较反应差者中明显,胆固醇代谢标志物变化差异不大。反应好者中,TC、LDLC的下降幅度与胆固醇代谢标志物均呈正相关;而反应差者中则均呈负相关。

Aim To investigate the changes of blood lipid and cholesterol metabolism markers（ cholesterol synthesis and absorption markers） in high-risk subjects of coronary heart disease before and after atorvastatin treatment,and to analyze the correlation between them. Methods 159 high-risk subjects of coronary heart disease were enrolled,and20 mg atorvastatin per day was taken for four weeks. Blood lipids and cholesterol synthesis markers squalene / cholesterol（ TC）,desmosterol/TC,lathosterol/TC） and cholesterol absorption markers（ sitosterol/TC,stigmasterol/TC,campesterol / TC） were determined respectively before and after treatment. According to the low density lipoprotein cholesterol（ LDLC） level after atorvastatin treatment,the selected subjects were divided into two groups： good response group and poor response group. The changes of blood lipid and cholesterol metabolism markers and their correlation were analyzed in the two groups. Results After atorvastatin treatment,blood lipids were reduced in two groups,in addition to high densitylipoprotein cholesterol increasing（ 9. 4% in good response group,7. 4% in poor response group）. TC,LDLC decreased significantly in good response group compared with the poor response group（ P〈0. 01）. In good response group,the decrease of TC was positively correlated with the decrease of squalene / TC and sitosterol / TC（ r = 0. 247,r = 0. 205,P〈0. 05）,and the decrease of LDLC was positively correlated with the decrease of campesterol / TC（ r = 0. 193,P〈0. 05）.In poor response group,the decrease of TC was negatively correlated with the decrease of stigmasterol / TC（ r =-0. 388,P〈0. 01）,and the decrease of LDLC was negatively correlated with the decrease of squalene / TC,stigmasterol / TC and sitosterol / TC（ r =-0. 280,P〈0. 05; r =-0. 517,P〈0. 01; r =-0. 320,P〈0. 05）. Conclusions After atorvastatin treatment,the changes of TC and LDLC in good response group are more obvious than those in poor response group,but the changes of cholesterol metabolism markers are not significant. In good response group,the decrease of TC and LDLC are positively correlated with cholesterol metabolism markers,whereas negative correlation is found in poor response group.