依折麦布联合阿托伐他汀类对低密度脂蛋白胆固醇未达标的急性冠脉综合征患者胆固醇代谢的影响

Effect of atorvastatin plus ezetimibe therapy on serum cholesterol synthesis and absorption metabolism in acute coronary syndrome patients not achieving LDL-C goal

目的探讨依折麦布联合阿托伐他汀类对低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)未达标的急性冠脉综合征(acute coronary syndrome,ACS)患者血清胆固醇代谢标记物7烯胆甾醇、24-脱氢胆甾烷醇、油菜甾醇、豆固醇和谷甾醇的影响。方法入选2012年6月-2014年6月于我院住院的ACS患者,常规应用他汀类药物4周后LDL-C未达标80例,随机分为双倍阿托伐他汀钙治疗组(40 mg,每晚1次)38例和阿托伐他汀钙联合依折麦布治疗组(阿托伐他汀钙20 mg,每晚1次;加用依折麦布10 mg,每晚1次)42例,治疗12周后,分析两组治疗前后血清胆固醇代谢标记物的变化。结果治疗12周后阿托伐他汀钙联合依折麦布治疗组LDL-C水平较双倍阿托伐他汀钙治疗组明显下降[(1.81±0.38)mmol/L vs(2.01±0.43)mmol/L,P<0.05],两治疗组7烯胆甾醇和24-脱氢胆甾烷醇水平较治疗前均下降,双倍阿托伐他汀钙治疗组下降更明显(P均<0.05)。治疗后12周后,阿托伐他汀钙联合依折麦布治疗组油菜甾醇、豆固醇和谷甾醇水平均明显下降,而双倍阿托伐他汀钙治疗组油菜甾醇、豆固醇和谷甾醇水平均明显上升。结论对于应用他汀类药物后LDL-C不达标的ACS患者,阿托伐他汀钙联合依折麦布可同时降低胆固醇代谢标记物7烯胆甾醇、24-脱氢胆甾烷醇、油菜甾醇、豆固醇和谷甾醇,更有效地降低LDL-C水平。

Objective To investigate the effects of atorvastatin combined with ezetimibe on serum cholesterol synthesis and absorption in acute coronary syndrome patients not achieving LDL-C goal. Methods Eighty ACS patients not achieving LDL-C goal in our hospital from June 2012 to June 2014 were randomly divided into atorvastatin plus ezetimibe group （n=42, atorvastatin 20 mg/d plus ezetimibe 10 mg/d） and atorvastatin double-dose group （n=38, atorvastatin 40 mg/d）. Serum cholesterol synthesis and absorption markers were measured before and after 12-week treatment. Results After 12 weeks, the serum LDL-C level was significantly lower in atorvastatin plus ezetimibe group than that in double dose atorvastatin group [（1.81 ± 0.38） mmol/L vs （2.01± 0.43） mmol/L, P 〈 0.05]. Serum cholesterol synthesis markers （lathosterol, 24-dehydrogenation） decreased after 12- week treatment in the two groups, particularly in double dose atorvastatin group. Cholesterol absorption markers （campesterol, stigmasterol, sitosterol） decreased in atorvastatin plus ezetimibe group after 12-week treatment （P 〈 0.05, respectively）. However, they increased in the double dose atorvastatin group. Conclusion Atorvastatin combined with ezetimibe reduce cholesterol synthesis and absorption markers at the same time in acute coronary syndrome patients not achieving LDL-C goal.