强化降脂治疗对老年不稳定性心绞痛病人的临床效果

Clinical Effects of Intensive Lipid-Lowering Treatment of Old Patients With Unstable Angina Pectoris

目的 :评价强化降脂治疗对老年不稳定性心绞痛 (UAP)病人预后的影响 ,探讨降脂药物的作用机制。方法 :确诊为老年UAP病人 79例 ,随机分为常规药物治疗组 (常规组 ,n =3 9)和常规药物加立普妥 (lipitor)组 (立普妥组 ,n =40 ) ,立普妥初始剂量 10mg/d ,根据低密度脂蛋白胆固醇达标情况 ( <2 6mmol/L)增量 ,最大剂量 40mg/d。以 12导联ST段压低数值总和 (∑ST)和 1周内心绞痛发作次数作为心肌缺血指标 ,空腹取静脉血测定血糖、甘油三酯、低密度脂蛋白胆固醇、血浆一氧化氮、纤溶酶原激活物抑制物、C 反应蛋白、心肌酶谱、肝肾功能及血、尿常规。 6个月后复测上述指标 ,同时观察半年内心脑血管事件。两组病人年龄、性别、血压、心率、吸烟、空腹血糖及危险分层比例无明显差异。结果 :6个月后共纳入病人 76例 (常规组 ,n =3 8;立普妥组 ,n =3 8)。用药前后比较 :两组病人用药后心绞痛发作次数及∑ST均较用药前明显下降 ,立普妥组下降更明显 ,均有显著性差异 (P <0 0 5及P <0 0 1) ;立普妥组治疗后较治疗前甘油三酯及低密度脂蛋白胆固醇明显下降 ,有显著性差异 (P <0 0 5及P <0 0 1) ,一氧化氮明显增加 ,有极显著性差异 (P <0 0 1) ;C 反应蛋白及纤溶酶原激活物抑制物明显降低 ,有显著性差异 (P <0

Objective: To evaluate the prognostic value of intensive lipid lowering treatment in old patients with unstable angina pectoris(UAP) and study the mechanism of lipid lowering drugs.Methods: Seventy nine old patients with UAP were randomly divided into group A(with conventional drugs) and group B(with conventional drugs and lipitor).Lipitor was given 10 mg/d to 40 mg/d according to various levels of LDL C (<2 6 mmol/L). The frequency of angina in 1 week and ∑ST(the sum total of ST depress of 12 leads) was recorded. Fasting blood glucose (FBG),TG, LDL C, serum NO, plasminogen activator inhibitor (PAI),C reactive protein(CRP),myocardial enzyme, liver function and kidney function were tested.Routine blood test and routine urine test were also done. The above data were examined again 6 months later. Cardiovascular and cerebrovascular events were observed for 6 months.Results: After 6 months, one patient in group A and two in group B were excluded. There was no difference in age,sex, blood pressure, heart rate, smoking, FBG and risk stratification between groups( p >0 05).The frequency of angina and ∑ST of both groups was decreased after treatment( p <0 05 or p <0 01).TG,LDL C, CRP and PAI were obviously decreased( p <0 05 or p <0 01).NO was markly increased ( p <0 01).The patients with acute myocardial infarction and those needed for percutaneous coronary intervention and coronary artery bypass grafe surgery were fewer in group B( p <0 05).The patients with apoplexy and those dying of sudden cardiac death were also fewer, but there was no statistical difference( p >0 05).Three patients had slight elevation of ALT and 2 had abdominal distension.Conclusions: ①Intensive lipid lowering treatment can obviously improve clinical prognosis in old patients with UAP. Making plaques stabilitized,improving endothelial function and anti inflammation may be the therapeutic mechanism of lipitor. ②Lipitor is a safe and effective lipid lowering drug.