依折麦布对冠心病调脂不佳患者脂糖代谢及肝肾功能的影响

Effects of ezetimibe on lipid and glucose metabolism and hepatorenal function in patients with coronary heart disease and poor lipid regulation

目的分析依折麦布对冠心病(CHD)调脂不佳患者脂糖代谢与肝肾功能的影响。方法选择2011年8月-2015年7月广州医科大学附属第三医院收治的84例冠心病伴血脂超标者作为研究对象,按就诊顺序编号,分为对照组与观察组,每组42例。两组均给予常规治疗,对照组给予辛伐他汀作调脂干预,观察组在对照组基础上加用依折麦布,两组均治疗3个月。比较治疗前后两组甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(Apo B)脂代谢水平的变化,统计两组血脂达标率,观察两组糖化血红蛋白(HbAlc)、空腹血糖(FBG)等糖代谢指标的变化,治疗期间均监测肝肾功能,测定谷丙转氨酶(ALT)、谷草转氨酶(AST)、尿素氮(BUN)、肌酐(Cr)水平,评价治疗的安全性。结果治疗前,两组脂代谢各指标对比差异无统计学意义(P>0.05),治疗后,观察组TC、TG、LDL-C、Apo B下降,幅度高于对照组(P<0.05),HDL-C上升,幅度高于对照组(P<0.05)。观察组血脂达标率为78.57%,高于对照组的42.86%(P<0.05)。治疗前,两组糖代谢对比差异无统计学意义(P>0.05),治疗后,观察组FBG降低,与对照组对比差异有统计学意义(P<0.05),但两组HbAlc对比差异无统计学意义(P>0.05)。治疗前,两组肝肾功能变化差异无统计学意义(P>0.05),治疗后,两组ALT、AST、BUN、Cr略有上升,但差异无统计学意义(P>0.05)。两组治疗期间肝肾功能异常发生率对比差异无统计学意义(P>0.05)。结论冠心病调脂不佳患者的临床治疗中采用依折麦布联合辛伐他汀干预,可提高血脂达标率,且安全性较高。

Objective To analyze the effects of ezetimibe on lipid and glucose metabolism and hepatorenal function in patients with coronary heart disease（CHD） and poor lipid regulation. Methods 84 cases of patients with coronary heart disease complicated by excessive blood lipids who were treated in our hospital between August 2011 and July 2015 were selected as study subjects. According to the order of treatment,the patients were numbered and randomized into the control group and the observation group,42 cases in each group. Both of the two groups were given routine therapy. The control group was given simvastatin for lipid regulation intervention. On this basis,the observation group was additionally given ezetimibe.Both of the two groups were treated for 3 months. The changes of levels of triglyceride（TG）,total cholesterol（TC）,high density lipoprotein cholesterol（HDL-C）,low density lipoprotein cholesterol（LDL-C）,apolipoprotein A1（ApoA1）,apolipoprotein B（Apo B） lipid metabolism before and after treatment were compared. The control rates of blood lipid in the two groups were statistically analyzed. The changes of glycosylated hemoglobin（Hb Alc）,fasting blood glucose（FBG） and other glucose metabolism indexes in the two groups were observed. The hepatorenal function was monitored during the treatment. The levels of glutamic-pyruvic transaminase（ALT）,glutamic oxalacetic transaminase（AST）,blood urea nitrogen（BUN） and creatinine（CR） were determined. The therapeutic safety was evaluated. Results Before treatment,there were no significant differences in the lipid metabolism indexes between the two groups（P〉0.05）. After treatment,TC,TG,LDL-C and Apo B levels in the observation group decreased,and the amplitude was higher than those in the control group（P〈0.05）. HDL-C level increased,and the amplitude was higher than that of the control group（P〈0.05）.The control rate of blood lipid of the observation group（78.57%） was significantly higher than that of the control group（42.86%）（P〈0.05）. Before treatment,there was no significant difference in glucose metabolism between the two groups（P〉0.05）. After treatment,FBG level in the observation group decreased. Compared with the control group,there was significant difference（P〈0.05）. However,there was no significant difference in HbAlc level between the two groups（P〉0.05）. Before treatment,there were no significant difference in hepatorenal function between the two groups（P〉0.05）. After treatment,ALT,AST,BUN and Cr levels increased slightly but there were only weakly significant difference in AST level（P=0.051）. The difference in the incidence of abnormal hepatorenal function between the two groups during treatment was not significant（P〉0.05）. Conclusion To apply ezetimibe combined with simvastatin intervention in the clinical treatment of patients with CHD and poor lipid regulation could improve the control rate of blood lipid and was safe.