不同营养状况高龄冠心病患者阿托伐他汀治疗效果及安全性分析

Efficacy and Safety of Atorvastatin in Elderly Patients with Coronary Heart Disease with Different Nutritional Status

目的分析不同营养状况高龄冠心病患者阿托伐他汀的治疗效果及安全性。方法选取2016年1月至2019年1月我院高龄(≥80岁)冠心病患者90例,使用MNA-SF量表进行评估后分为营养正常组(n=45)和营养不良组(n=45),采用阿托伐他汀(20 mg/d)治疗6个月后,检测患者的血清总蛋白、白蛋白、总胆固醇(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)、肌酐(Scr)、丙氨酸氨基转移酶(ALT)、肌酸激酶水平(CK),同时记录1年内不良事件发生情况。结果营养正常组与营养不良组之间的性别、高血压、吸烟人数比例及年龄、总蛋白比较,差异均无统计学意义(P>0.05),而MNA-SF总分和白蛋白营养不良组均小于营养正常组,差异有统计学意义(P<0.05)。营养不良组和营养正常组治疗后TC、LDL-C水平较治疗前均明显降低,且治疗后营养正常组TC、LDL-C水平较营养不良组显著降低,差异有统计学意义(P<0.05)。治疗后TG和HDL-C水平虽分别呈下降和上升趋势,但与治疗前比较差异无统计学意义(P>0.05)。治疗后营养不良组ALT水平较治疗前显著增高,且较治疗后营养正常组ALT水平显著增高(P<0.05);CK和Scr水平治疗前后差异均无统计学意义(P>0.05)。营养不良组高龄患者不良心血管事件发生率明显高于营养正常组(P<0.05)。结论在使用阿托伐他汀治疗高龄老年冠心病伴营养不良患者时,容易增加药物的毒副反应和心血管不良事件发生率,临床应用时应综合考虑患者病情。

Objective To analyze the therapeutic effect and safety of atorvastatin in elderly patients with coronary heart disease with different nutritional status.Methods A total of 90 elderly(≥80 years old)patients with coronary heart disease were collected in the Second People’s Hospital of Jiulongpo District,Chongqing from January 2016 to January 2019.After evaluation with MNA-SF scale,they were divided into well nourished group(n=45)and malnourished group(n=45).After treatment with atorvastatin(20 mg/day)for 6 months,the serum total protein,albumin,total cholesterol(TG),low density lipoprotein(LDL-C),high density lipoprotein(HDL-C),triglyceride(TG),creatinine(Scr),alanine aminotransferase(ALT),creatine kinase(CK)and cardiovascular adverse events within 1 year were recorded.Results There were no significant difference in gender,hypertension,smoking proportion,age and total protein between normal and malnourished groups(P>0.05),but the total score of MNA-SF and albumin in malnourished group were lower than those in normal group(P<0.05).The levels of TC and LDL-C in malnutrition group and normal nutrition group after treatment were significantly lower than those before treatment,and the levels of TC and LDL-C in normal nutrition group after treatment were significantly lower than those in malnutrition group.Although the levels of TG and HDL-C decreased and increased after treatment,respectively,there was no significant difference between the two groups.The ALT level in malnutrition group was significantly higher than that before treatment,and than that in normal nutrition group after treatment.There was no significant difference in CK and Scr levels before and after treatment.Malnutrition group could significantly increase the incidence of adverse cardiovascular events in elderly patients(P<0.05).Conclusion When atorvastatin is used in the treatment of elderly patients with coronary heart disease and with malnutrition,it will increase the side effects and the incidence of cardiovascular adverse events.The patients’condition should be comprehensively considered in clinical application.