不同剂量阿托伐他汀治疗急性冠脉综合征患者降脂效果及对主要心脑血管事件的影响

The influence of different doses of atorvastatin on lipid-lowering and cardiovascular and cerebrovascular events in patients with acute coronary syndrome

目的探讨不同剂量阿托伐他汀对急性冠脉综合征(ACS)患者降脂效果及主要心脑血管事件的影响。方法回顾性分析2013年1月-2014年12月心血管内科75例ACS患者,入院后首次给予阿托伐他汀20mg(20mg组,n=45)或40mg(40mg组,n=30)剂量治疗,维持治疗6个月。对比观察2组治疗1、6个月血脂和肝功能指标变化情况,评估2组维持治疗6月主要心脑血管事件发生情况。结果治疗前,2组TC、LDL-C水平差异无统计学意义(P>0.05)。治疗1、6个月时2组TC、LDL-C均显著降低(P均<0.05),其中40mg组TC和LDL-C下降幅度显著大于20mg组,差异均有统计学意义(P<0.05)。治疗前与治疗1、6月时2组均未见转氨酶>3×ULN病例。2组均未见严重肌肉不良事件和肾脏毒性发生。治疗6个月内,40mg组和20mg组主要心脑血管事件发生率分别为20%和42.2%,2组比较差异有统计学意义(P<0.05)。结论 ACS患者接受40mg剂量阿托伐他汀维持治疗是安全的,降脂效果更佳,并可降低主要心脑血管事件风险。

Objective To investigate the efficacy and major adverse cardiac and cerebral events of the atorvastatin with different dosages in acute coronary syndrome( ACS) patients.Methods From December 2014 to January 2013,75 patients with ACS in our hospital were treated with atorvastatin of 20 mg/d( 20 mg group,n = 45) or 40 mg/d( 40 mg group,n = 30)for 6 months.The changes of blood lipid and liver function were observed in the two groups,and the major adverse cardiac and cerebral events( MACCE) in the two groups were evaluated.Results The level of TC、LDL-C before treatment of 2 groups was no statistically significant( P > 0.05).The level of TC、LDL-C 1,6 months after treatment were lower than that before treatment,Wherein the 40 mg group TC and LDL-C decline was significantly higher than 20 mg group,the differences were statistically significant( P < 0.05).Before treatment and 1,6months after treatment,detected the liver function.There were no transaminases > 3 × ULN cases.2 groups were no adverse events severe muscle and kidney toxicity.Within 6 months of treatment,40 mg group and 20 mg group major cardiovascular event rate was 20% and 42.2%,respectively,wherein the 40 mg group cardiovascular event rate was significantly lower than 20 mg group,the difference was statistically significant( P < 0.05).Conclusion ACS patients receiving maintenance therapy with high-dose atorvastatin of 40 mg/d is superior to conventional-dose,and has good safety,and can reduce the risk of MACCE.