阿托伐他汀联合海博麦布对急性冠脉综合征行介入治疗患者血脂的影响分析

The effect analysis of atorvastatin combined with hybutimibe on blood lipids in patients with acute coronary syndrome undergoing interventional therapy

目的观察阿托伐他汀联合海博麦布对急性冠状动脉(冠脉)综合征(ACS)行介入治疗患者血脂的影响。方法选择68例行介入治疗的ACS患者,均给予阿托伐他汀联合海博麦布治疗。比较患者治疗前后血脂指标[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白B(ApoB)、非高密度脂蛋白胆固醇(非HDL-C)]、肝肾功能指标[总胆红素(TBIL)、丙氨酸氨基转移酶(ALT)、肌酐(Cr)]、骨骼肌损伤指标[肌酸激酶(CK)];分析患者治疗后不良反应发生情况。结果治疗第4周,患者TC(3.37±0.51)mmol/L、LDL-C(2.45±0.35)mmol/L、ApoB(0.61±0.14)g/L、非HDL-C(2.34±0.42)mmol/L均低于入选时的(3.98±0.62)mmol/L、(2.84±0.44)mmol/L、(0.69±0.14)g/L、(2.95±0.55)mmol/L,差异有统计学意义(P<0.05),HDL-C、TG水平与入选时比较差异无统计学意义(P>0.05);治疗第8周,患者TC、LDL-C、非HDL-C水平均低于治疗第4周,差异有统计学意义(P<0.05),ApoB、HDL-C、TG水平与治疗第4周比较差异无统计学意义(P>0.05)。治疗第4周,患者ALT[28.0(16.6)]U/L、CK(88.0±30.8)U/L均高于入选时的[21.4(17.7)]、(76.8±25.0)U/L,差异有统计学意义(P<0.05),TBIL、Cr水平与入选时比较差异无统计学意义(P>0.05);治疗第8周,患者ALT水平高于治疗第4周,差异有统计学意义(P<0.05),TBIL、CK、Cr水平与治疗第4周比较差异无统计学意义(P>0.05)。治疗第4周,1例患者因ALT严重升高退出,停服阿托伐他汀后ALT降至正常;1例患者CK升高,阿托伐他汀剂量减为10 mg/次,1次/d后第8周CK降至正常,均考虑为阿托伐他汀的不良反应;其他患者均未因肝功能、肌酸激酶、肾功能异常导致停药情况,也未发生其他因不良反应导致停药的情况。结论海博麦布与阿托伐他汀联用可进一步降低TC、LDL-C、ApoB、非HDL-C,可安全的用于ACS行介入治疗后的患者,不良反应轻微。

Objective To observe the effect of atorvastatin combined with hybutimibe on blood lipids in patients with acute coronary syndrome(ACS)undergoing interventional therapy.Methods A total of 68 patients with ACS undergoing interventional therapy were selected and were given atorvastatin combined with hybutimibe.The lipid indices[total cholesterol(TC),triglycerides(TG),high-density lipoprotein cholesterol(HDL-C),lowdensity lipoprotein cholesterol(LDL-C),apolipoprotein B(ApoB),and non-high-density lipoprotein cholesterol(non-HDL-C)],hepatic and renal function indices[total bilirubin(TBIL),alanine aminotransferase(ALT),creatinine(Cr)],and markers of skeletal muscle injury[creatine kinase(CK)]were compared before and after treatment;the occurrence of adverse reactions after treatment was analyzed.Results At the 4th week of treatment,patients had TC of(3.37±0.51)mmol/L,LDL-C of(2.45±0.35)mmol/L,ApoB of(0.61±0.14)g/L,and non-HDL-C of(2.34±0.42)mmol/L,which were lower than(3.98±0.62)mmol/L,(2.84±0.44)mmol/L,(0.69±0.14)g/L,and(2.95±0.55)mmol/L at enrollment,and the differences were statistically significant(P<0.05),but there were no statistically significant differences in HDL-C and TG levels compared with those at enrollment(P>0.05).At the 8th week of treatment,the levels of TC,LDL-C and non-HDL-C were lower than those at the 4th week of treatment,and the differences were statistically significant(P<0.05),while the levels of ApoB,HDL-C and TG were not statistically significant compared with those at the 4th week of treatment(P>0.05).At the 4th week of treatment,patients had ALT of[28.0(16.6)]U/L and CK of(88.0±30.8)U/L,which were higher than[21.4(17.7)]and(76.8±25.0)U/L at enrollment,and the difference was statistically significant(P<0.05),and there was no significant difference in TBIL and Cr levels compared with those at enrollment(P>0.05).At the 8th week of treatment,ALT level was higher than that at the 4th week of treatment,and the difference was statistically significant(P<0.05),while TBIL,CK and Cr levels were not statistically significant compared with those at the 4th week of treatment(P>0.05).At the 4th week of treatment,1 patient withdrew due to severe elevation of ALT,which decreased to normal after discontinuing atorvastatin;1 patient had elevated CK,which decreased to normal at the 8th week after the dose of atorvastatin reduced to 10 mg/d once/d;all of them were considered to be the adverse reactions of atorvastatin.No other patients were discontinued due to abnormalities in liver function,creatine kinase,or renal function,and no other discontinuations due to adverse reactions occurred.Conclusion The combination of hybutimibe and atorvastatin can further reduce TC,LDL-C,ApoB,and non-HDL-C,and can be safely used in patients with ACS after interventional therapy,with minimal adverse reactions.