阿托伐他汀钙联合非诺贝特治疗混合型高脂血症合并高尿酸血症的临床观察

Clinical observation of atorvastatin combined with fenofibrate in treating mixed hyperlipidemia and hyperuricemia

目的探讨阿托伐他汀钙联合非诺贝特治疗高脂血症合并高尿酸血症的疗效及安全性。方法选择混合型高脂血症伴高尿酸血症患者182例,按照随机数字表法分为A组60例,B组61例和C组61例。A组患者每次给予阿托伐他汀钙10mg·d^(-1),口服;B组患者每次给予非诺贝特200 mg·d^(-1),口服;C组患者每次给予阿托伐他汀钙10 mg·d^(-1)加非诺贝特200mg·d^(-1),口服。比较血清总胆固醇(TC)、低密度脂蛋白(LDL-C)、甘油三酯(TG)、高密度脂蛋白(HDL-C)和血尿酸(BUA)的变化及用药过程中的不良反应。结果治疗8周后,3组患者的TG[A、B、C组分别为(2.95±0.35)、(1.54±0.29)、(1.64±0.35)mmol·L^(-1)]、TC[A、B、C组分别为(4.68±0.53)、(5.20±0.64)、(4.20±0.42)mmol·L^(-1)]、LDL-C[A、B、C组分别为(2.95±0.35)、(1.54±0.29)、(1.64±0.35)mmol·L^(-1)]均较治疗前TG[A、B、C组分别为(3.52±0.40)、(3.48±0.45)、(3.66±0.38)mmol·L^(-1)];TC[A、B、C组分别为(6.55±0.89)、(6.31±0.67)、(6.33±0.73)mmol·L^(-1)];LDL-C[A、B、C组分别为(3.35±0.52)、(3.23±0.46)、(3.31±0.44)mmol·L^(-1)]降低,HDL-C[A、B、C组分别为(1.39±0.35)、(1.49±0.29)、(1.52±0.33)mmol·L^(-1)]较治疗前[A、B、C组分别为(1.35±0.37)、(1.32±0.30)、(1.28±0.36)mmol·L^(-1)]上升,总体差异有统计学意义(P<0.05)。治疗后B组和C组患者血清TG均低于A组(P<0.05),且B组、C组的血清HDL-C均高于A组(P<0.05)。A组和C组患者血清TC和LDL-C均低于B组(P<0.05)治疗后B组和C组患者BUA水平[分别为(298.5±39.9)、(282.7±45.6)μmol·L^(-1)]显著低于A组(391.3±55.2μmol·L^(-1))(P<0.05)。3组患者不良反应的发生率(A、B、C组分别为13.33%、6.56%、11.48%)差异无统计学意义(P>0.05)。结论阿托伐他汀钙联合非诺贝特能有效降低高脂血症合并高尿酸血症患者血清TG、TC、LDL-C和BUA的水平,同时升高HDL-C的水平,且不良反应发生率低,值得临床推广。

Objective To investigate the efficacy and safety of atorvastatin combined with fenofibrate in the treatment of mixed hyperlipemia and hyperuricemia.Methods A total of 182 patients of mixed hyperlipidemia and hyperuricemia treated from December 2013 to December 2015 in Baoji Central Hospital were selected and randomized into group A（n = 60） group B（n = 61） and group C（n =61）.Patients in group A were given atorvastatin calcium 10 mg·d^-1,po patients in group B were given fenofibrate 200 mg·d^-1,po,and patients in group C were given atorvastatin calcium 10 mg·d^-1 and fenofibrate 200 mg·d^-1,po.Changes of serum TC,LDL-C,TG,HDL-C,serum uric acid（BUA） and adverse reaction among 3 groups were compared.Results After 8 weeks of treatment,TG（group A：2.95 ±0.35 mmol·L^-1 group B：1.54 ± 0.29 mmol·L^-1 group C：1.64 ± 0.35 mmol·L^-1）,TC（group A：4.68 ±0.53 mmol·L^-1 group B：5.20 ±0.64 mmol·L^-1 group C：4.20 ±0.42 mmol·L^-1） and LDL-C（group A：2.95 ±0.35 mmol·L^-1 group B：1.54 ±0.29 mmol·L^-1 group C：1.64 ±0.35 mmol·L^-1） were lower than those before treatment（TG：3.52 ±0.40,3.48 ±0.45 3.66 ± 0.38 mmol·L^-1 respectively;TC：6.55 ± 0.89,6.31 ± 0.67,6.33 ± 0.73 mmol·L^-1 respectively;LDL-C：3.35 ±0.52,3.23 ±0.46,3.31 ±0.44 mmol·L^-1 respectively）,and HDL-C（1.39 ±0.35,1.49 ±0.29,1.52 ±0.33 mmol·L^-1respectively） were higher than those before treatment（1.35 ± 0.37,1.32 ±0.30,1.28 ± 0.36 mmol·L respectively） with total difference being statistically significant（P0.05）.After treatment,serum TG of group B and group C were lower than that of group A（P〈0.05） and HDL-C of group B and group C were higher than that of group A（P〈0.05）.Serum TC and LDL-C of group A and group C were lower than that of group B（P〈0.05）.After treatment,the levels of BUA in group B and group C（298.5 ± 39.9 282.7± 45.6 μmol·L^-1 respectively） were significantly lower than that of group A（391.3 ± 55.2 μmol·L^-1）（P〈0.05）.The incidences of adverse reactions in 3 groups of patients（13.33%,6.56%,11.48%respectively） were not significantly different（P〈0.05）.Conclusions Atorvastatin combined with fenofibrate can effectively reduce the serum TG TC,LDL-C and BUA level of mixed hyperlipemia and hyperuricemia patients,increase HDL-C level and the incidence of adverse reactions is low,which can be clinically promoted.