瑞舒伐他汀联合依折麦布对老年急性脑梗的降脂效果与安全性研究

Curative Effects and Safety of Rosuvastatin Combined with Ezetimibe in Hyperlipidemia Elderly Patients with Acute Cerebral Infarction

[目的]研究瑞舒伐他汀联合依折麦布对老年急性脑梗死血脂未达标患者的降脂效果和安全性。[方法]入选89例急性脑梗死患者，A组46例给予瑞舒伐他汀（10mg／d）联合依折麦布（10mg／d）治疗，B组43例给予瑞舒伐他汀（10mg／d）治疗，治疗2周及12周后观察两组患者血脂水平及肝功能，肌酶变化并进行比较。[结果]治疗2周后两组患者低密度脂蛋白胆固醇（LDL-C）平均下降比例分别为32．7％和17．3％；而治疗12周后平均下降比例分别为48．4％和27．2％，组间比较A组下降较B组更早更快，差异有显著统计学意义（均P〈0．001），且和B组相比肝功能，肌酶等无变化，治疗12周后A组达标率56．5％（26例），B达标率20．9％（9例），差异有显著统计学意义（P=0．002）。治疗12周后总胆固醇（TC）下降约45％和28％，与B组比较差异有显著统计学意义（P=0．003）。治疗12周后三酰甘油（TG）下降，而高密度脂蛋白胆固醇（HDLC）升高，但与治疗前比较均无统计学意义。[结论]瑞舒伐他汀联合依折麦布对老年急性脑梗死患者不增加肝毒性和肌毒性且能使LDL—C达标时间缩短，达标率升高。

[Objective]To study the effects and safety of the combination of ezetimibe and rosuvastatin on the levels of blood-lipids in elderly patients with acute cerebral infarction. [Methods]A total of 89 patients with acute cerebral infarction were recruited and randomly assigned to group A （rosuvastatin 10mg/d,ezetimibe 10 mg/d, n =46） and group B（rosuvastatin 10 mg/d, n =43）.The observation targets of all patients were assessed after 2 weeks and 12 weeks of treatment. The changes of blood-lipids, alanine ami-notransferase （ALT）, aspartate aminotransferase （AST）, and creatine kinase （CK） were compared before and after treatment.[Results] Compared to before treatment, the levels of low-density lipoproteins （LDL-C） after 2 weeks of treatment in both groups were decreased, dropping at ratios of 32.7% and 17.3%, respectively. However, after 12 weeks of treatment, the decreasing ratios were 48.4% and 27.2%. respectively; the levels of LDL-C in group A dropped earlier and more quickly than in group B. There was a statistically significant difference （ P 〈0.001）, No correlation existed between improvement of liver enzyme level （ALT and AST） and muscle enzyme level （CK）. The rate of reaching guideline target of LDL-C 12 weeks after treatment was 56.5% （26 cases） in group A and 20.9% （9 cases） in group B; there was a statistically significant difference （ P =0.002）. The levels of total cholesterol （TC） fell by about 45% and 28% after 12 weeks of treatment, with significant difference between group A and group B （ P =0.003）. After 12 weeks of treatment the levels of triglycerides （TG） decreased, while levels of high-density lipoproteins （HDL-C） increased, but showed no statistical significance compared to before treatment. [Conclusion]Our study demonstrated that it is feasible to initiate combination therapy in elderly patients with acute cerebral infarction,which can shorten the time it takes for LDL-C levels to reach the guideline target and increase the rate of reaching the guideline target while not increasing liver or muscle toxicity.