他汀类药物对心肾功能的影响

他汀类药物是广泛应用于临床的降脂药，其降脂作用是通过抑制3-羟甲基戊二酸单酰辅酶A（HMG—CoA）还原酶活性，减少甲羟戊酸的合成，使血总胆固醇和低密度脂蛋白胆固醇（LDL—C）含量下降。近年的研究表明，他汀类除降脂作用外，尚有抗炎、抗氧化、抗血栓和抗增殖作用。大规模临床试验的亚组分析显示，他汀类可延缓慢性心肾功能不全患者的心肾功能恶化，降低病死率，提高生活质量。     

阿司匹林联合他汀类药物治疗冠心病的效果及对患者心功能的影响

目的探讨阿司匹林联合他汀类药物治疗冠心病的效果及对患者心功能的影响。方法80例冠心病患者随机分为两组各40例,对照组给予阿司匹林治疗,研究组给予阿司匹林联合阿托伐他汀治疗,比较两组的临床疗效、心绞痛发作持续时间以及心功能指标。结果研究组的治疗总有效率为95.0%,高于对照组的75.0%(P<0.05)。治疗后,研究组的心绞痛发作持续时间短于对照组,LVEDD、LVESD均低于对照组,LVEF高于对照组(P<0.05)。结论阿司匹林联合他汀类药物治疗冠心病的效果显著,可有效缩短患者的心绞痛发作持续时间,改善患者的心功能。     

来自PLANET研究的最新数据探索他汀类药物对有肾损害患者的肾功能影响

在2010年6月底第47届欧洲透析和移植大会上,PLANET研究结果的公布再次引起学术界对他汀类药物肾脏安全性问题的关注。其中PLANET1评估瑞舒伐他汀10～40mg/d及阿托伐他汀80mg/d对进展性肾病合并糖尿病患者肾脏的影响,而PLANET2则是评估瑞舒伐他汀10～40mg/d及阿托伐他汀40～80mg/d对进展性肾病无糖尿病患者肾脏的影响。两个研究随访时间为52周,观察指标有患者的尿蛋白/肌酐比值、肾小球滤过率（eGFR）以及其他指标的改变。PLANET研究结果发现,     

他汀类药物与脑卒中的研究进展

降脂治疗在脑卒中防治中的作用已逐渐受到人们的重视。他汀类药物可以有效降低脑卒中患者的血脂水平，同时还具有保护脑及血管的作用。     

他汀类药物与脑卒中的研究进展

降脂治疗在脑卒中防治中的作用已逐渐受到人们的重视.他汀类药物可以有效降低脑卒中患者的血脂水平,同时还具有保护脑及血管的作用.     

他汀类药物的不良反应

他汀类药物是治疗胆固醇高血脂症、动脉粥样硬化的常用药物,其不良反应有报道,应引起临床的重视.     

他汀类药物与癌症

他汀类药物是临床上最常见的降胆固醇的处方药,用于治疗和预防各种心血管疾病与高脂血症。应用他汀类药物治疗的患者须谨慎,必须考虑到他汀类药物的安全性、毒性、与其他药物的相互作用以及患者的健康状况。既往研究表明,他汀类药物可导致癌症,但近期最新研究却证实他汀类药物可降低癌症风险[1-2]。本文中就这一问题综述如下。     

他汀类药物治疗高脂血症的研究进展

高脂血症是指脂肪代谢或运转异常使血液中的血脂含量超过正常值,表现为胆固醇和(或)三酰甘油过高,是一种发病率较高的疾病.高脂血症是导致心脑血管疾病的主要因素,该疾病可加速全身动脉粥样硬化,对人体的损害是进行性和全身性的.因而需要给予高脂血症患者有效的降血脂治疗.临床对于高脂血症的治疗主要是药物治疗,包括他汀类、贝特类、烟...     

他汀类药物的多效性对老年人骨密度的影响观察

目的 观察他汀类药物的多效性对老年人骨密度(BMD)的影响.方法 序贯入选2016年12月～2018年1月在体系医院确诊为高脂血症伴老年骨质疏松症患者64例.根据治疗方式分为观察组(阿托伐他汀组)34例和对照组(血脂康组)30例.观察组服用阿托伐他汀20 mg,l次/d;对照组服用血脂康0.6g,2次/d.分别于治疗前...     

Effects of a stanol-enriched diet on plasma cholesterol and triglycerides in patients treated with statins

BACKGROUND: Plant stanols have been recommended in combination with individualized dietary interventions to reduce plasma cholesterol concentrations. It is unclear whether plant stanols in combination with dietary guidance in patients already using optimal doses of statins will further reduce fasting and postprandial lipids compared with standard care. STUDY DESIGN: This single-blind, randomized study investigated the effect of plant stanols in margarines, combined with a lipid-lowering dietary intervention, in patients already on lipid-lowering medications at maximal doses not reaching their target lipid levels. Nutrition education was based on the stages of change theory. The control group (which served as the standard care control group) was also taking optimal doses of statins. This group received a margarine without plant stanols and a leaflet with Dutch nutrition guidelines. Fasting lipids were measured once in venous samples and postprandial lipemia was assessed by self-measured triglycerides in an outpatient setting. All subjects were given a capillary triglyceride measuring device (Accutrend GCT, Roche Diagnostics, Mannheim, Germany) and were instructed to measure their capillary triglycerides at six fixed time-points throughout the day on three different days. The mean area under the triglyceride curve represented total daylong triglyceridemia, which has been shown to reflect postprandial triglyceridemia. Twenty patients were included, 11 in the intervention group and 9 in the control group. RESULTS: In the plant stanol group, low-density lipoprotein cholesterol decreased significantly by 15.6% compared with a reduction of only 7.7% in the control group. The daylong triglyceridemia was similar in both groups at the beginning and at the end of the study, and no change was observed by the intervention. CONCLUSION: Intensive dietary intervention with addition of plant stanols results in clinically relevant reduction of low-density lipoprotein cholesterol in patients optimally treated with statins, compared with similar patients on statins receiving only standard care. The use of a plant stanol-enriched margarine did not decrease postprandial triglyceridemia in these patients.     

Effects of ethanol on platelet function

To obtain evidence for an ethanol mediated disruption of hemostasis we compared the effects of acute and chronic ethanol ingestion on platelet reactivity. Since ADP may be important for hemostasis in vivo it was used to induce platelet aggregation in platelet-rich plasma. Thromboxane B2 (TXB2) formed during the aggregation was measured by radioimmunoassay. Ethanol (1.5 g/kg) given to 8 healthy non-alcoholic male volunteers increased platelet reactivity to ADP and the associated TXB2 formation rose from 289 +/- 60 (mean +/- SE) to 984 +/- 263 fmol/10(7) platelets (p less than 0.025). The effects lasted for as long as ethanol was present in blood. In 13 non-cirrhotic male alcoholics the withdrawal of ethanol caused a 4-fold increase in TXB2 formation within one week but the basal levels before ethanol withdrawal were the same as in controls. These findings are discussed in relation to the higher risk of brain infarction seen in alcoholics and even associated with binge drinking. Further studies are needed to establish the effects of ethanol on prostacyclin formation.     

Effects of aging on immune function

A variety of changes are observed in the immune system in both animals and humans with increasing age. There is a decline in the functional capacity of the cell populations that mount generalized and focused immune responses, and decreasing production and response of these cells to regulatory signals and proteins. These changes translate into less effective innate and adaptive immune responses, increased reactivity against self-antigens in vivo, and an increased incidence of infection. There may also be an increased risk of mortality. The mechanisms underlying age-related changes in immune function are not fully understood, but are likely to be multifactorial, including environmental and behavioral factors that affect over-all immune function from the molecular level to that of the entire organism.     

Pleiotropic effects of statins

Statins safely and effectively reduce the morbidity and mortality due to cardiovascular disease. In the trials conducted so far, which have been carried out predominantly on high-risk patients, the observed risk reduction is probably completely attributable to the reduction of the cholesterol level. However, statins also influence the atherosclerotic disease process in a lipid-independent way. This includes beneficial effects on the early pathogenetic components of atherosclerosis, such as endothelial dysfunction and inflammation. These effects are probably not visible in the large clinical trials that usually follow up cohorts of patients with late stages of atherosclerosis during a relatively short period of time. These cholesterol-independent effects do affect intermediate factors in the atherosclerotic process, such as endothelial dysfunction. In clinical practice, where not only short-term effects in patients with manifest vascular disease but also the prevention of the long-term complications of atherosclerosis in high-risk patients is an important goal, these so-called pleiotropic effects may contribute to risk reduction.     

他汀类药物的安全性问题

自2001年西立伐他汀撤出市场后,他汀类药物的安全性成为人们关注的一个重要问题.随着降脂研究的不断深入和大规模临床试验结果的不断报道,他汀类药物的临床应用越来越广泛,已成为冠心病防治的重要药物,目前世界上数百万人在服用他汀类药物,他汀类药物的年销售额为数十亿元人民币,积累了丰富的他汀类药物的临床试验资料.     

原研他汀药及国产仿制他汀药的依从性及成本效果比较

目的 探索原研他汀药和国产仿制他汀药在服药依从性、降胆固醇幅度和成本效果的差异。方法 从北京市朝阳区社区卫生服务中心信息系统中提取2015年1月至2017年12月首次处方他汀药的≥18岁患者处方记录,筛选出41 496条原研他汀药处方记录和60 491条国产仿制他汀药处方记录,比较首次处方后1年内的服药依从性,对服药依从性较好的患者比较服药1年后两组药物降低胆固醇的幅度,并采用成本-比值法进行成本效果分析。结果 国产仿制他汀药的服药依从性（28.2%）较原研药差（36.2%）,差异有统计学意义（P<0.001）。在服药依从性较好且1年内未更换或调整药物剂量的患者中,调整个体年龄、性别、高血压、糖尿病病史及社区内相关性的影响后,199名一直服用国产仿制阿托伐他汀（20 mg/d）的患者1年后降低TC［降低幅度：（0.86±0.07）mmol/L vs.（0.40±0.10）mmol/L,P<0.001］和LDL-C［降低幅度：（0.67±0.07）mmol/L vs.（0.42±0.08）mmol/L,P=0.003］的幅度大于服用相同成分和剂量原研药的患者（232名）,且降低相同幅度的胆固醇可以节省50%以上的医药费。结论 尽管国产仿制他汀药依从性较差,但有可能在降胆固醇效果上替代原研药并降低患者经济负担,但本研究证据级别有限且缺乏不良反应数据,有必要开展高质量的临床研究推动国产仿制药的发展。