不同降脂方案治疗他汀不耐受冠状动脉粥样硬化性心脏病患者的效果分析

Effects of different lipid-lowering treatments on coronary atherosclerotic heart disease patients with statin intolerance

目的比较对他汀不耐受的冠状动脉粥样硬化性心脏病(冠心病)患者采用每天依折麦布治疗方案或每周2次间断阿托伐他汀治疗方案或每周2次间断阿托伐他汀联合每天依折麦布治疗方案的有效性和安全性。方法选择2014年1月至2017年6月于首都医科大学附属北京安贞医院急诊综合病房与武警北京市总队医院心内科住院的不耐受每日他汀治疗的冠心病患者121例,完全随机分为依折麦布组(40例)、阿托伐他汀组(41例)、联合用药组(40例)。依折麦布组给予依折麦布10 mg/d治疗;阿托伐他汀组给予阿托伐他汀10 mg/次、每周2次治疗;联合用药组给予依折麦布10 mg/d联合阿托伐他汀10 mg/次、每周2次治疗。比较3组用药12周后血脂水平及与药物有关的不良反应。结果用药12周后,依折麦布组、联合用药组三酰甘油、总胆固醇、LDL-C均明显低于用药前[依折麦布组:(1.4±0.4)mmol/L比(2.2±0.6)mmol/L、(4.2±0.7)mmol/L比(5.2±0.9)mmol/L、(3.2±0.6)mmol/L比(3.9±0.7)mmol/L;联合用药组:(1.4±0.4)mmol/L比(2.2±0.6)mmol/L、(3.8±0.6)mmol/L比(5.2±0.8)mmol/L、(2.8±0.5)mmol/LL比(3.9±0.7)mmol/L],阿托伐他汀组总胆固醇、LDL-C均明显低于用药前[(4.2±0.8)mmol/L比(5.3±0.7)mmol/L、(3.1±0.6)mmol/L比(3.9±0.7)mmol/L],差异均有统计学意义(均P<0.05)。联合用药组用药12周后总胆固醇、LDL-C均明显低于依折麦布组,三酰甘油、总胆固醇、LDL-C均明显低于阿托伐他汀组,差异均有统计学意义(均P<0.05)。联合用药组用药12周后LDL-C达标率明显高于依折麦布组和阿托伐他汀组[22.5%(9/40)比2.5%(1/40)、2.4%(1/41)],差异均有统计学意义(均P<0.05)。治疗过程中3组均无严重不良反应发生。结论对于他汀不耐受的冠心病患者,采用间断阿托伐他汀联合依折麦布的治疗方案,可以提高他汀使用的依从性,并加强降脂效应,提高降脂治疗的达标率。

Objective To analyze the lipid-lowering effects of ezetimibe and atorvastatin on coronary atherosclerotic heart disease（CHD） patients with statin intolerance. Methods Totally 121 CHD patients intolerant to statins from January 2014 to June 2017 in Beijing Anzhen Hospital, Capital Medical University and Armed Police Beijing Corps Hospital were randomly divided into ezetimibe group（10 mg/d， n=40）, atorvastain group（10 mg, twice a week，n=41） and combination group（ezetimibe combined with atorvastain, n=40）. Changes of blood lipid indicators and occurrence of adverse drug reactions were analyzed after 12 weeks of treatment. Results Levels of triacylglycerol（TG）, total cholesterol（TC） and low-density lipoprotein cholesterol（LDL-C） after treatment were significantly lower than those before treatment in ezetimibe group and combination group［ezetimibe group： （1.4±0.4）mmol/L vs（2.2±0.6）mmol/L, （4.2±0.7）mmol/L vs（5.2±0.9）mmol/L, （3.2±0.6）mmol/L vs（3.9±0.7）mmol/L； combination group： （1.4±0.4）mmol/L vs（2.2±0.6）mmol/L, （3.8±0.6）mmol/L vs（5.2±0.8）mmol/L, （2.8±0.5）mmol/L vs（3.9±0.7）mmol/L］（P＜0.05）. Levels of TC and LDL-C after treatment were significantly lower than those before treatment in atorvastain group［（4.2±0.8）mmol/L vs（5.3±0.7）mmol/L, （3.1±0.6）mmol/L vs（3.9±0.7）mmol/L］（P＜0.05）. After treatment, levels of TC and LDL-C in combination group were significantly lower than those in ezetimibe group; levels of TC, TG and LDL-C in combination group were significantly lower than those in atorvastain group（P＜0.05）. After 12 weeks of treatment, rate of LDL-C level reaching the standard in combination group was significantly higher than that in ezetimibe group and atorvastain group［22.5%（9/40） vs 2.5%（1/40）, 2.4%（1/41）］（P＜0.05）. There was no severe adverse reaction during treatment. Conclusion Ezetimibe combined with atorvastatin treating CHD patients with statin intolerance can effectively improve the lipid-lowering effect.