急性冠脉综合征患者采用短期强化他汀治疗对肾小球滤过率的影响及安全性分析

目的探讨短期强化他汀治疗在急性冠脉综合征患者治疗中的临床疗效和肾脏安全性。方法急性冠脉综合征患者共199例,按单双号随机入组分为强化组(n=99例)与常规组(n=100例),强化组入院及住院期间(平均8.3天)均给予阿托伐他汀钙片80mg每晚,出院后给予阿托伐他汀钙片40mg每晚;常规组入院及住院期间(平均8.1天)均给予阿托伐他汀钙片20mg每晚,出院后给予阿托伐他汀钙片20mg每晚。于入院及出院后1个月检测两组患者相关生化指标并进行比较。结果强化组治疗1个月后,其胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDLC)等均较前显著下降(P0.05)。而高密度脂蛋白(HDL-C)升高明显(P0.05),肾小球滤过率较前明显改善(P0.05)。与常规组比较,强化组1个月后其肝酶及肌酸激酶等无明显增加,但肌酐水平较前有所下降(P0.05)。同时患者的血同型半胱氨酸及超敏CRP水平较前下降(P0.05)。结论短期强化他汀治疗在确保用药安全的情况下,能快速有效较低患者的TC、TG、LDL-C及同型半胱氨酸水平,并且能有效的改善患者肾功能及肾小球滤过率水平,提高HDL-C。

The Effects and Safety of Short-term Intensive Statin Therapy on Glomerular Filtration Rate in Patients with Acute Coro -nary Syndrome

Objective To evaluate the clinical efficacy and kidney safety of short-term intensive statin therapy in patients with acute coronary syndrome (ACS) .Methods A total of 199 ACS patients admitted in Hangzhou First People’s Hospital were enrolled into this study .The patients were randomly assigned to receive atorvastatin 80mg/night during hospitalization ,and 40mg/night after discharge for one month (intensive group ,n = 99) ;or receive atorvastatin 20 mg/night during hospitalization and 20 mg/night after discharge for one month (control group ,n = 100) .The biochemical indexes were measured and compared on the admission and after one-month treatment .Results After one-month treatment ,the total cholesterol (TC) ,triglycerides (TG) and LDL cholesterol (LDL-C) of inten-sive group were significantly lower ,and the high density lipoprotein cholesterol (HDL-C) was significantly higher than baseline values (P< 0 .05) .The Glomerular filtration rates were significantly improved compared with baseline values (P < 0 .05) .Compared with the control group ,the liver enzymes and creatine kinase in intensive group were not significantly changed ,but the creatinine level was significantly decreased (P< 0 .05) .Meanwhile ,the blood homocysteine and ultra-sensitivity C-reactive protein levels were also sig-nificantly decreased compared with the baseline valies (P< 0 .05) .Conclusions In the circumstance of drug safety ,short-term inten-sive statin therapy can effectively reduce TC ,TG ,LDL-C and homocysteine levels in patients while improve the glomerular filtration rate and renal protective effect ,which resulted to higher HDL cholesterol levels .