不同调脂方案对不稳定性心绞痛患者内皮功能及安全性的影响

Effects of different lipid-lowering regimens on endothelial function and safety in patients with unstable angina

目的研究不同调脂方案对不稳定性心绞痛患者血脂、内皮功能及安全性的影响。方法连续入选2018年9月至2019年5月因不稳定性心绞痛就诊河南省人民医院的患者,随机(随机数字法)分为常规治疗组、强化他汀组和强化降脂组,按照预定调脂方案给予治疗,分别在1、3、6个月进行随访,随访内容包括血脂四项、肝功能、肌酶、超敏C反应蛋白(high sensitive C-reactive protein,hs-CRP)、内皮功能反应性充血指数(reactive hyperemia index,RHI)、缺血事件、肌痛以及停药情况。应用单因素方差分析、χ2检验或Fisher确切概率法分析三组患者各指标的差异,组间两两比较采用SNK-q检验。结果共入组375例,随机分为三组,每组125例,三组患者人口学资料及用药情况差异无统计学意义。1个月时强化他汀组低密度脂蛋白胆固醇(LDL-C)达标率明显高于常规治疗组(χ2=3.939,P=0.047)和强化降脂组(χ2=4.63,P=0.031),3个月时强化他汀组和强化降脂组LDL-C降幅明显优于常规治疗组(q=8.862,P<0.01和q=9.699,P<0.01),6个月时强化降脂组LDL-C降幅优于强化他汀组(q=4.332,P<0.01)。RHI和hs-CRP改善情况,1个月时强化他汀组明显优于常规治疗组(q=3.412,P<0.05;q=4.133,P<0.05),3个月和6个月时强化他汀组和强化降脂组均较常规治疗组改善明显(均P<0.05)。从治疗3个月开始,强化他汀组和强化降脂组心血管事件发生率较常规治疗组有降低趋势,但差异无统计学意义。在治疗6个月时,强化他汀组和强化降脂组停药比率明显高于常规治疗组(χ2=4.488,P=0.03和χ2=5.039,P=0.02)。肝酶和肌酶升高比率以及肌痛发生率三组比较均差异无统计学意义(均P>0.05)。结论强化他汀治疗能够使不稳定性心绞痛患者LDL-C尽早达标,炎症指标和内皮功能明显改善,且安全性好。

Objective To investigate the effects of different lipid-lowering regimens on blood lipids,endothelial function and safety in patients with unstable angina.Methods Patients who admitted to Henan Provincial People's Hospital for unstable angina from September 2018 to May 2019 were randomly(random number)divided into the conventional treatment group,intensive statin group and intensive lipid-lowering group.Follow-up was performed at 1,3,and 6 months after treatment according to the predetermined lipid-lowering regimen.Assessments included lipid profile,liver function,muscle enzymes,hypersensitive C-reactive protein(hs-CRP),endothelial function(reactive hyperemia index,RHI),ischemic events,myalgia,and discontinuation.The differences of the follow-up indicators among the three groups were analyzed.Results A total of 375 patients were enrolled and randomly divided into three groups,125 patients in each group.There were no significant differences in demographic data and medication among the three groups.At the 1st month,the low density lipoprotein cholesterin(LDL-C)compliance rate of the intensive statin group was significantly higher than those in the conventional treatment group(χ2=3.939,P=0.047)and the intensive lipid-lowering group(χ2=4.63,P=0.031).At the 3rd month,the reductions of LDL-C in the intensive statin group and the intensive lipid-lowering group were significantly better than that in the conventional treatment group(P<0.01).At the 6th month,the reduction rate of LDL-C in the intensive lipid-lowering group was higher than that in the intensive statin group(q=4.332,P<0.01).At the 1st month,the improvement of hs-CRP and RHI in the intensive statin group was significantly better than that in the conventional treatment group(q=4.133,P<0.05).From the 3rd month of treatment,the incidence of cardiovascular events in the intensive statin group and the intensive lipid-lowering group showed a tendency to decrease compared with the conventional treatment group,but no statistically significant difference was found.At the 6th months of treatment,the withdrawal rates were significantly higher in the intensive statin group and the intensive lipid-lowering group than that in the conventional treatment group(χ2=4.488,P=0.03 andχ2=5.039,P=0.02).There were no significant differences in the ratio of liver enzyme and muscle enzyme elevation and the incidence of myalgia among the three groups(all P>0.05).Conclusions Intensive statin therapy can make LDL-C reach the standard in patients with unstable angina pectoris as soon as possible,significantly improve inflammation indicators and endothelial function,and has good safety.