冠状动脉粥样硬化性心脏病患者间断瑞舒伐他汀联合依折麦布治疗的效果分析

Efficacy of intermittent dosage regimen of rosuvastatin combined with ezetimibe in treatment of coronary atherosclerotic heart disease

目的探讨间断瑞舒伐他汀联合依折麦布治疗冠状动脉粥样硬化性心脏病（冠心病）的效果。方法选择2016年1—9月首都医科大学附属北京安贞医院85例不耐受每日他汀类药物治疗（尝试2种及以上不同种类他汀，包括至少1种脂溶性和／或1种水溶性他汀）的冠心病患者，完全随机分为单独用药组（43例）与联合用药组（42例）。单独用药组给予依折麦布10mg／a治疗；联合用药组给予依折麦布（10mg／d）联合瑞舒伐他汀（5mg／次，每周2次）治疗。观察12周，监测并记录治疗前及治疗12周时2组各项血脂指标[总胆固醇、三酰甘油、高密度脂蛋白胆固醇（HDL—C）及低密度脂蛋白胆固醇（LDL—C）]及与药物有关的不良反应。结果2组患者基本临床资料和不能耐受他汀类药物的原因相似，差异均无统计学意义（P〉0．05）。治疗后，2组患者总胆固醇和LDL—C均明显低于治疗前[单独用药组：（4．3±0，8）mmol／L比（5．2±0．9）mmol／L、（3．2±0．6）mmol／L比（3．9±0．8）mmol／L；联合用药组：（3．8±0．6）mmol／L比（5．2±0．8）mmol／L、（2．8±0．5）mmol／L比（3．9±0．8）mmol／L]，差异有统计学意义（P〈0．05）；单独用药组三酰甘油和HDL—C与治疗前比较差异无统计学意义（P〉0．05），但联合用药组三酰甘油明显低于治疗前，HDL—C明显高于治疗前[（1．4±0．4）mmol／L比（2．2±0．6）mmol／L、（1．6±0．4）mmol／L比（1．2±0，3）mmol／L]，差异有统计学意义（P〈0．05）。联合用药组患者总胆固醇、三酰甘油、LDL—C在治疗12周时明显低于单独用药组，差异有统计学意义（P〈0．05）。单独用药组治疗12周时LDL—C达标率为0，联合用药组治疗12周时达标率为23．8％（10／42），2组比较差异有统计学意义（P〈0．05）。治疗过程中2组均无严重不良反应发生。结论对于他汀类药物不耐受的冠心病患者，采用间断瑞舒伐他汀联合依折麦布的给药方案，可以提高他汀类药物使用的依从性，并加强降脂效应，提高降脂治疗的达标率。

Objective To explore the effect of intermittent dosage regimen of rosuvastatin combined with ezetimibe on coronary atherosclerotic heart disease（CHD）. Methods A total of 85 CHD patients who had statins intolerance from January 2016 to September 2016 in Beijing Anzhen Hospital, Capital Medical University were randomly divided into ezetimibe group（ 10 mg/d, n = 43 ） and combined treatment group （ ezetimibe 10 mg/d and rosuvastatin twice a week, n = 42 ）. Blood lipid indexes [ total cholesterol （TC）, triacylglycerol （TG）, high density lipoprotein cholesterol （HDL-C） and low density lipoprotein cholesterol （LDL-C）] before treatment and after 12 weeks of treatment were tested and adverse drug effects were recorded. Results Baseline data and reasons for statins intolerance had no significant differences between groups （P 〉 0. 05 ）. TC and LDL-C significantly decreased after treatment compared to the baseline in both groups [ ezetimibe group ： （ 4.3 ± 0.8 ） mmol/L vs （5.2±0.9）mmol/L,（3.2 ±0.6）mmoL/L vs （3.9 ±0. 8）mmol/L; combined treatment group： （3. 8 ± 0.6）mmol/Lvs （5.2 ±0.8）mmol/L,（2.8 ±0.5）mmol/L vs （3.9±0.8）mmol/L] （P〈0.05）; TG and HDL-C had no significant difference before and after treatment in ezetimibe group ; TG in combined treatment group significantly decreased after treatment and HDL-C significantly increased compared to the baseline [ （ 1.4 ± 0.4） mmol/L vs （2.2 ± 0.6） mmol/L, （ 1.6 ± 0.4） mmol/L vs （ 1.2 ± 0.3 ） mmol/L ] （ P 〈 0.05 ）. TC, TG and LDL-C in condoined treatment group were significantly lower than those in ezetimibe group after treatment （ P 〈 0. 05 ）. The standard-reaching rate of LDL-C in ezetimibe group was 0; the standard-reaching rate of LDL-C in combined treatment group was 23.8% （10/42） ; there was a significant difference between groups （P 〈0. 05）. No severe adverse reaction was observed during treatment. Conclusion Intermittent dosage regimen of rosuvastatin combined with czetimibe treating CHD with statins intolerance can improve statins compliance and lipid-lowering effect.