合并乙型病毒性肝炎的冠心病病人应用他汀类药物临床观察研究

Clinical observation of statins in patients with coronary heart disease complicated with hepatitis B

目的分析应用不同剂量阿托伐他汀钙联合降脂胶囊对合并乙型病毒性肝炎的冠心病病人的血脂指标、肝功和内皮功能的影响。方法随机选取某院2014年1月~2017年1月接受治疗的120例合并乙型病毒性肝炎的冠心病病人,采用随机数字表法分为A组、B组和C组,每组40例。A组病人给予10 mg/d的阿托伐他汀钙联合降脂胶囊治疗,B组病人给予20 mg/d的阿托伐他汀钙联合降脂胶囊治疗,C组病人给予5 mg/d的阿托伐他汀钙联合降脂胶囊治疗。比较3组病人在治疗前和治疗后6个月的血脂指标三酰甘油(Three Glycerol,TG)、总胆固醇(Tatal Cholesterol,TC)、低密度脂蛋白胆固醇(Low Density Lipoprotein Cholesterol,LDL-C)、高密度脂蛋白胆固醇(High Density Lipoprotein Cholesterol,HDL-C)、肝功血清谷丙转氨酶(Alanine transaminase,ALT)水平、肝功能损害发生率、内皮功能指标内皮素-1(endothelin-1,ET-1)和一氧化氮(nitric oxide,NO)水平。结果治疗后,B组病人的血清ALT水平和肝功能损害发生率比A组和C组明显升高,差异有统计学意义(P<0.05),A组和C组病人的ALT水平和肝功能损害发生率差异均无统计学意义(P>0.05);C组病人的TC、TG、LDL-C和ET-1水平均比A组和B组明显升高,差异有统计学意义(P<0.05),C组病人的NO水平比A组和B组明显降低,差异有统计学意义(P<0.05),A组和B组的ET-1、NO、TC、TG、LDL-C水平差异均无统计学意义(P>0.05),3组病人的HDL-C水平差异无统计学意义(P>0.05)。结论剂量为10 mg/d的阿托伐他汀钙联合降脂胶囊方案的疗效最佳,能有效地减轻合并乙型病毒性肝炎的冠心病病人的肝功损害,调节机体血脂代谢,且不会影响病人内皮功能的恢复,值得临床广泛应用。

Objective To investigate the influence of atorvastatin calcium of different dose combined with jiangzhi capsule on the blood lipid, liver function and endothelial function of patients coronary heart disease with hepatitis B. Methods A total of 120 patients with coronary heart disease and hepatitis B in our hospital from January 2014 to January 2017 were randomly selected and divided into group A and group B, 40 patients each group. The patients of group A were treated with atorvastatin calcium（ 10 mg/ d） with jiangzhi capsule, patients of group B were treated with atorvastatin calcium（20 mg/d）with jiangzhi capsule, and patients of group C were treated with atorvastatin calcium （5 mg/d）with jiangzhi capsule. The blood lipid index TG, TC, LDL - C, HDL - C, liver function, ALT, ET - 1, NO and the incidence of liver dysfunction of two groups were compared before and 6 months after treatment. Results After treatment, the level of ALT and incidence of liver function damage in group B were significantly higher than those in group A and C, and there was significantly difference（P 〈 0.05 ）. After treatment, the level of ALT and incidence of liver function damage between group A and C were no significantly difference （ P 〉 0.05 ）. The level of TC, TG, ET - 1 and LDL - C in the group C after treatment were significantly higher than those in the group A and B, and there was significantly difference（ P 〈 0. 05 ）. The level of NO in the group C after treatment were significantly lower than those in the group A and B, and there was significantly difference（P 〈0.05）. The level of ET - 1, NO, TC, TG and LDL - C between group A and B were no significantly difference（P 〉 0.05 ）. After treatment, the level of HDL -C between three groups were no significantly difference（P 〉 0.05 ）. Conclusion The Atorvastatin calcium （10 mg/d）with jiangzhi capsule can effectively reduce the liver damage on patients coronary heart disease with hepatitis B virusat, regulate metabolism of blood lipid, and don＇ t effect the recovery of endothelial function. It is worthy of clinical application.