瑞舒伐他汀治疗冠心病伴高脂血症的疗效及其对血脂、炎性介质及内皮指标的影响

Effects of rosuvastatin on blood lipid,inflammatory mediators,endothelial function in patients with coronary heart disease and hyperlipidemia

目的观察瑞舒伐他汀对冠心病伴高脂血症的临床疗效及对血脂、炎性介质和内皮指标的影响。方法选择2015年2月—2017年2月四川省甘孜州人民医院心血管内科住院治疗的冠心病伴高脂血症患者98例作为研究对象,采用随机数字表法分为观察组49和对照组49例。2组患者均给予抗高血压、糖尿病基础治疗。观察组给予瑞舒伐他汀10 mg/次晚餐后顿服,1次/d;对照组给予辛伐他汀片20 mg/次晚餐后顿服,1次/d;2组患者均连续治疗12周。比较2组患者临床疗效,分别于治疗前后检测2组患者血脂(TC、TG、HDL-C、LDL·C、CRP、Apo-Al、Apo-B)、炎性介质、内皮指标(CPR、APN、NO、ET-1)和肝肾功能(ALT、CK、SCr、BUN)水平,并记录2组不良反应发生率。结果治疗12周后,观察组总有效率高于对照组(93.9%vs.79.6%,χ~2=4.346,P=0.037);观察组TG、TC、LDL-C、ApoAl、Apo-B低于对照组,HDL-C显著高于对照组(t=4.124、11.121、7.126、2.005、1.898、2.102,P=0.000、0.000、0.000、0.024、0.030、0.019);观察组CRP、ET-1水平低于对照组,APN、NO水平高于对照组(t=1.791、17.167、33.295、16.324,P=0.038、0.000、0.000、0.000);2组ALT、CK、SCr、BUN比较差异无统计学意义(t=0.070、0.319、0.629、0.098,P=0.472、0.375、0.265、0.461);观察组发生呕吐、腹泻、皮疹、肌痛等不良反应发生率低于对照组(χ~2=3.971、4.382、5.869、4.186,P=0.046、0.036、0.015、0.041)。结论瑞舒伐他汀可提高冠心病伴高脂血症患者临床疗效,能够降低血脂,减轻炎性反应,对肝肾功能影响小,安全性高,值得临床推广。

Objective To investigate the clinical efficacy and effects of rosuvastatin on blood lipid,inflammatory mediators,liver and kidney function in patients with coronary heart disease and hyperlipidemia.Methods Ninety-eight cases of patients with coronary heart disease and hyperlipidemia were selected,who were treated in hospital from February 2015 to February 2017,and they were divided into the observation group（49 cases）and control group（49 cases）.The patients of two groups were all treated with antihypertensive,diabetic basic treatment.The patients of observation group were treated with rosuvastatin（taken after dinner,1 tablet/time,1 time/d）.The patients of control group were treated with simvastatin tablets（taken after dinner,1 tablet/time,1 time/d）.The patients of two groups were all treated for 12 weeks.The clinical efficacy,the incidence of adverse reactions and changes of the levels of blood lipid（TC、TG、HDL-C、LDL-C）,inflammatory mediators（CRP,APN,NO,ET-1）,liver and kidney function（ALT,CK,SCr and BUN）of two groups were compared.Results After the appropriate treatment for 12 weeks,the patients of the observation group got a total effective rate of 93.8%,which was significantly better than the 79.6%of the control group（x2=4.346,P=0.037）;The levels of TG,TC,LDL-C,Apo Al,Apo B of the observation group were significantly lower than those of the control group（t=4.124,t=11.121,t=7.126,t=2.005,t=1.898,P=0.000,P=0.000,P=0.000,P=0.024,P=0.030,P=0.019）,the levels of HDL-C of the observation group were significantly higher than those of the control group（t=2.102,P=0.000）;CRP、ET-1 levels of observation group were lower than control group,while APN,NO levels were higher than control group（t=1.791,17.167,33.295,16.324,P=0.038,P=0.000,P=0.000,P=0.000）.There were no significant difference in ALT,CK,SCr and BUN between the two groups（t=0.070,t=0.319,t=0.629,t=0.098,P=0.472,P=0.375,P=0.265,P=0.461）;There were vomiting,diarrhea,rash,myalgia,elevated ALT and other adverse reactions occurred in both two groups,and the incidence of observation group were significantly lower than that in the control group（x2=3.971,x2=4.382,x2=5.869,x2=4.186,P=0.046,P=0.036,P=0.015,P=0.041）.Conclusion Treating patients with coronary heart disease and hyperlipidemia,rosuvastatin can improve clinical efficacy,reduce blood lipids,reduce inflammatory response,and its impact on liver and kidney function is small,with high safety,which makes it worthy of clinical promotion.