瑞舒伐他汀在冠心病合并糖尿病治疗中的应用价值

目的：观察瑞舒伐他汀对冠心病合并糖尿病患者非高血脂状态下进行强化治疗后的临床心血管事件，提出早期强化降脂的必要性。方法选择冠心病合并糖尿病患者324例，入院检测低密度脂蛋白胆固醇-C（LDL-C＜3．36 mmol/L），将其随机分为他汀组176例（瑞舒伐他汀10 mg/d）和对照组148例，所有患者均经过强化降糖、抗血小板、抗心肌缺血、戒烟、调整饮食、加强运动等冠心病二级预防治疗，必要时行冠状动脉造影及冠状动脉内支架植入术或是冠状动脉旁路移植术等。随访（13±6）个月，观察指标：空腹血糖、LDL-C、高敏C反应蛋白及临床心血管事件（心脏性猝死、再发心绞痛及靶血管重建等）。结果他汀组患者空腹血糖、LDL-C及hs-CRP均显著比对照组降低血糖：（5．3±0．9） mmol/L 与（6．7±1．2） mmol/L，P＝0.042；LDL-C：（1．7±0.6）mmol/L与（3．9±1．6）mmol/L，t＝-2．36，P＜0．01；hs-CRP：（1．4±0．5）mmol/L与（3．8±1．2）mg/L，t＝-2．48，P＜0.01，临床心血管事件（15．6％与37．1％），χ2＝4．78，P＝0．032。结论应该早期强化对冠心病合并糖尿病患者进行降脂治疗，即使血脂不高，可以显著降低临床心血管事件。

Applicated value of rosuvastatin in the treatment of coronary heart disease patients with diabetes

Objective To compare main adverse cardiac events of patients with coronary heart disease and diametes,but normal lipids after statin on lowering lipids , and to bring out necessity of early lowering lipids . Methods A total of 324 patients with coronary heart disease and diametes were enrolled ,LDL-C was measured in-hospital for all patients and LDL-C〈3.36mmol/L suitable for the experiment .They were divided into statin group （n=176,rosuvastatin 10 mg/d）and control group（n=148）randomly,all patients received second prevention for cor-onary heart disease including anti-platelet,anti-myocardial ischemia,smoke quitting,adjust diets and exercise,the CAG or PTCA（and stent implanting）,CABG.the end events were main adverse cardiac events （cardiac events,recur-rent angina and target vessel reconstruction ）.The mean follow-up time was（13 ±6）months.Results The fasting plasma glucose,LDL-C,hs-CRP in statin group were all significantly lower than those of control group FPG：（5.3 ± 0.9）vs.（6.7 ±1.2）mmol/L,P=0.042;LDL-C：（1.7 ±0.6）mmol/Lvs.（3.9 ±1.6）mmol/L,P〈0.01;hs-CRP：（1.4 ±0.5）mmol/L vs.（3.8 ±1.2）mg/L,P 〈0.01],MACE were less（15.6% vs.37.1%,P =0.032）. Conclusion Early statin on patient with coronary heart disease and diametes ,though normal lipids ,which can down-regulate main adverse cardiac events significantly .