血脂康对不稳定型心绞痛伴肝酶升高患者的疗效与安全性

目的探讨血脂康对不稳定型心绞痛伴肝酶升高患者的疗效与安全性。方法纳入96例服用阿托伐他汀后引起肝酶升高3倍以上的不稳定型心绞痛患者。随机均分为3组,每组32例患者,A组停阿托伐他汀;B组阿托伐他汀减半;C组更换为血脂康。总疗程为4周,治疗前后测定总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、甘油三脂(TG)、高敏C反应蛋白(hs-CRP)、丙氨酸转氨酶(ALT)。随访主要不良心血管事件(MACEs),包括心源性死亡、致死性心肌梗死(MI)、非致死性MI、猝死发生情况。结果与治疗前比较,治疗4周后三组患者ALT水平均显著下降,治疗前后比较有统计学差异(P0.05),A、C组患者ALT水平下降较B组患者更显著,与B组患者比较有统计学差异(P0.05),A、C组之间ALT水平比较,无统计学差异(P0.05)。B、C组患者治疗4周后TC、LDL-C、TG、hs-CRP水平均下降,治疗前后比较有统计学差异(P0.05);C组患者HDL-C水平较治疗前升高(P0.05),治疗前后比较有统计学差异(P0.05);A组患者TC、LDL-C、TG、hs-CRP水平下降不明显,治疗前后比较无统计学差异(P0.05)。与A组患者治疗后比较,C组患者TG、hs-CRP水平明显下降,差异有统计学意义(P0.05)。A组、B组、C组MACEs事件发生率分别为12.5%、9.4%、3.1%,组间比较差异有统计学意义(P0.05)。结论他汀引起肝酶显著升高的不稳定型心绞痛患者,换用血脂康安全有效。本研究入选患者病例数较少,有待更多的试验证实。     

稳心颗粒联合阿托伐他汀治疗阵发性房颤的效果及对心功能、血清NT-proBNP水平的影响

目的探讨稳心颗粒联合阿托伐他汀治疗阵发性房颤(PAF)的效果及对心功能、血清N末端B型脑钠肽(NT-proBNP)水平的影响。方法将我院2016年1月至2018年1月收治的52例PAF患者随机分为观察组和对照组,各26例,对照组采用阿托伐他汀治疗,观察组在对照组基础上加用稳心颗粒联合治疗,两组均治疗6个月后评定疗效,并测定患者治疗前后左室收缩末期内径(LVESD)、左室舒张末期内径(LVEDD)、左室射血分数(LVEF)、心脏指数(CI)、心搏量(SV)等心功能指标变化,分别于治疗前、治疗后1、3、6个月测定患者血清中NT-proBNP水平。结果观察组患者临床有效率为92.31%,明显高于对照组的69.23%(P<0.05);治疗后观察组LVESD、LVEDD等心功能指标明显低于对照组,LVEF、CI、SV等指标明显高于对照组(P<0.05);治疗后两组NT-proBNP水平均明显降低,观察组降低幅度高于对照组(P<0.05)。结论稳心颗粒联合阿托伐他汀治疗PAF效果显著,可明显改善心功能,降低NT-proBNP水平。     

丹参川芎嗪联合阿托伐他汀对2型糖尿病合并颈动脉粥样硬化患者的血脂及颈动脉血流参数的影响

目的 探究丹参川芎嗪注射液联合阿托伐他汀钙片对2型糖尿病合并颈动脉粥样硬化患者血脂及颈动脉血流参数的影响。方法 选取2016年3月-2018年5月杨凌示范区医院收治的80例2型糖尿病合并颈动脉粥样硬化患者,根据入院顺序随机分为对照组和观察组,每组各40例。对照组在常规控制血糖的基础上口服阿托伐他汀钙片,10 mg/次,2次/d;观察组在对照组的基础上静脉滴注丹参川芎嗪注射液,10 mL用生理盐水稀释至250 mL,1次/d。两组均治疗6个月。比较治疗前后两组患者血脂及颈动脉血流参数。结果 治疗后,两组三酰甘油（TG）、总胆固醇（TC）、低密度脂蛋白胆固醇（LDLC）均明显低于治疗前,高密度脂蛋白胆固醇（HDL-C）明显高于治疗前,同组治疗前后比较差异有统计学意义（P<0.05）;且观察组各指标明显优于对照组,两组比较差异有统计学意义（P<0.05）。治疗后,两组阻力指数（RI）、搏动指数（PI）均明显低于治疗前,血液平均流速（V_mean）与收缩期血液峰值流速（PSV）均明显高于治疗前,同组治疗前后比较差异具有统计学意义（P<0.05）;且观察组各指标显著优于对照组,两组比较差异具有统计学意义（P<0.05）。结论 丹参川芎嗪注射液联合阿托伐他汀钙片治疗2型糖尿病合并颈动脉粥样硬化可有效降低患者血脂水平,改善颈动脉血流参数,从而改善颈动脉粥样硬化,值得临床推广应用。     

Statins and cardiovascular outcomes in elderly and younger patients with coronary artery disease: a post hoc analysis of the GREACE study

Introduction

The effect of cardiovascular disease (CVD) prevention measures aimed at elderly patients requires further evidence. We investigated the effect of statin treatment (targeted to achieve guideline goals) on CVD outcomes in different age groups to determine whether statins are more beneficial in the elderly.

Material and methods

The primary endpoint of this post hoc analysis of the GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study (n = 1,600 patients with established coronary heart disease (CHD), mean follow-up 3 years) was the absolute and relative CVD event (a composite of death, myocardial infarction, revascularization, unstable angina, heart failure and stroke) risk reduction in age quartiles (each n = 200). Patients on “structured care” with atorvastatin (n = 800) followed up by the university clinic and treated to lipid goal were compared with the corresponding quartiles on “usual care” (n = 800) followed up by specialists or general practitioners of the patient''s choice outside the hospital.

Results

In the elderly (mean age 69 ±4 and 70 ±3 years in the “structured” and “usual care”, respectively) the absolute CVD event reduction between “structured” and “usual care” was 16.5% (p < 0.0001), while in the younger patients (mean age 51 ±3 years and 52 ±3 years in the “structured” and “usual care”, respectively) this was 8.5% (p = 0.016); relative risk reduction (RRR) 60% (p < 0.0001) vs. 42% respectively (p = 0.001). The elderly had higher rates of chronic kidney disease and higher uric acid levels, plus an increased prevalence of diabetes, metabolic syndrome and non-alcoholic fatty liver disease. These factors might contribute to the increased CVD risk in older patients.

Conclusions

All age groups benefited from statin treatment, but the elderly on “structured care” had a greater absolute and relative CVD risk reduction than the younger patients when compared with the corresponding patients assigned to “usual care”. These findings suggest that we should not deprive older patients of CVD prevention treatment and lipid target achievement.     

Clinical Efficacy of Subgingivally Delivered 1.2% Atorvastatin in Chronic Periodontitis: A Randomized Controlled Clinical Trial

Background: Atorvastatin (ATV) is a specific competitive inhibitor of 3‐hydroxy‐2‐methyl‐glutaryl coenzyme A reductase. Recently, statins have shown pleiotropic effects such as anti‐inflammation and bone stimulation. The aim of the present study is to investigate the effectiveness of 1.2% ATV as an adjunct to scaling and root planing (SRP) in the treatment of intrabony defects (IBDs). Methods: Sixty individuals were randomized into two treatment groups: SRP plus 1.2% ATV and SRP plus placebo gel. At baseline and 3, 6, and 9 months, clinical parameters, which included modified sulcus bleeding index, plaque index, probing depth (PD), and clinical attachment level (CAL), were recorded at baseline. Radiologic assessment of IBD fill was done using computer‐aided software at baseline and 6 and 9 months. Results: Mean PD reduction and mean CAL gain were greater in the ATV group than the placebo group at 3, 6, and 9 months. A significantly greater mean percentage of radiographic bone fill was found in the ATV group (35.49% ± 5.50%) compared to the placebo group (1.82% ± 1.32%) after 9 months. Conclusion: ATV as an adjunct to SRP can provide a new direction in the management of IBDs.     

阿托伐他汀在大鼠颈总动脉球囊损伤模型中对NF-κB及其相关炎性因子的影响

目的研究阿托伐他汀在大鼠颈总动脉球囊损伤模型中对核转录因子NF-κB及其相关炎性因子:细胞间细胞黏附分子1(ICAM-1)、血管细胞黏附分子1(VCAM-1)、单核细胞趋化蛋白1(MCP-1)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)的影响。方法健康雄性Wistar大鼠72只,体重300～350 g,随机分为3组,阿托伐他汀干预组为实验组,通过灌胃法给予阿托伐他汀[10 mg/(kg.d)];安慰剂对照组为模型组,给予等量清水;空白对照组为假手术组,只分离出左颈总动脉后缝合,不作球囊损伤处理,给予等量清水。药物干预3天后实验组与模型组行左侧颈总动脉内膜球囊损伤术,术后实验组继续每日给予阿托伐他汀,模型组及假手术组给予等量清水,每组中各有6只于术后1、3、7天和14天分别处死,采集血清及颈总动脉标本。采用组织形态学观察内膜增生,采用免疫组织化学及酶联免疫吸附试验检测NF-κB及ICAM-1、VCAM-1、MCP-1、IL-6、TNF-α等炎性因子的表达。结果阿托伐他汀组球囊损伤后内膜增生面积显著小于模型组(P<0.01);模型组血管壁及血清中NF-κB及炎性因子ICAM-1、VCAM-1、MCP-1、IL-6、TNF-α的表达显著高于假手术组;阿托伐他汀组血管壁及血清中NF-κB及炎性因子ICAM-1、VCAM-1、MCP-1、IL-6、TNF-α的表达显著低于模型组(P<0.01)。结论阿托伐他汀能抑制大鼠颈总动脉损伤后的内膜增生,其可能机制是通过特异性抑制炎症关键调节因子NF-κB,从而减少其下游炎性因子ICAM-1、VCAM-1、MCP-1、IL-6及TNF-α的表达而实现的。     

急诊PCI术前阿托伐他汀强化治疗对STEMI患者血清炎症因子的影响

目的：探讨术前给予80mg阿托伐他汀强化治疗对ST段抬高急性心肌梗死（STEMI）患者急诊介入治疗前后炎症反应的影响。方法：入选STEMI的患者95例,随机分为三组：A组（31例,术前给予负荷剂量阿托伐他汀80mg,术后给予阿托伐他汀40mg／d）;B组（34例,术前不服用他汀类药物,术后给予阿托伐他汀40mg／d）;c组（30例,术前不服用他汀类药物,术后给予常规剂量阿托伐他汀20mg／d）。分别于术前,术后24h、3d、7d测定各组血清高敏C反应蛋白（hsCRP）、血清淀粉样蛋白酶A（SAA）水平及术后肌酸激酶-同工酶（CK—MB）的峰值。结果：三组间术前血清hsCRP及SAA水平无明显差异;术后3d及7d,A组血清hsCRP及SAA水平明显低于B组、c组[7d：hsCRP（5．64±1．55）mg／L比（8．36±2．32）mg／L、（7．66±2．53）mg／L,SAA（7．31±3．61）mg／L比（10．13±5．13）mg／L、（12．86±4．98）mg／L,P〈0．051;而B组与C组间无显著差异（P〉0．05）。术后A组CK—MB峰值水平明显低于B、C组[（233．9±102．71）IU／L比（319．40±111．10）IU／L、（373．6±174．87）[U／L,P〈0．05],而B组与c组间无显著差异（P〉0．05）。A组在研究期间药物安全性与B、c两组比较亦无显著差异。结论：急诊PCI术前给予80mg阿托伐他汀强化治疗可显著降低ST段抬高急性心肌梗死患者血清炎性因子水平及肌酸激酶一同工酶峰值水平,且安全性良好。     

Combined Hyperlipidemia In A Single Subject With Tetraplegia: Ineffective Risk Reduction After Atorvastatin Monotherapy

Abstract

Background/Objective: Effects of atorvastatin (Lipitor) drug monotherapy (1 0 mg daily) on fasting blood Iipid profiles and cardiovascular disease (CVD) risks were examined for a single subject with C5-C6 tetraplegia. Routine fasting Iipid profiles were analyzed by standard biochemistry techniques for total cholesterol (TC) , triglycerides (TG) , low-density lipoprotein-cholesterol (LDL-C) , and high-density lipoprotein-cholesterol (HDL-C). Lipid profiles were analyzed on 3 occasions before drug therapy was initiated and 3 months after therapy commenced. The TC:HDL and LDL:HDL ratios were computed for all sampling times and used to assess pretreatment and post-treatment CVD risk.

Results: Fasting TC, TG, and LDL-C were all significantly reduced by therapy. The pretreatment HDL-C of 3 5 mg/ dl was lowered to 21 mg/ dl. As a result, the TC:HDL risk ratiowas only marginally reduced from 6 .6 to 6.4, whereas the LDL:HDL risk ratio remained unchanged by treatment.

Conclusions: In this man with tetraplegia, atorvastatin drug monotherapy rapidly lowered TC, TG, LDL-C, and HDL-C. However, the TC: HDL ratio, considered the best predictor of CVD risk, was unchanged.     

Atorvastatin and pitavastatin reduce oxidative stress and improve IR/LDL-R signals in Alzheimer’s disease

Abstract

Objectives: To examine and compare the pleiotropic effects on oxidative stress and metabolic signaling pathways of atorvastatin and pitavastatin in mouse model of Alzheimer’s disease (AD).

Methods: We gave the transgenic (Tg) mice either atorvastatin or pitavastatin from 5–20 months (M) of age, and performed immunohistological analysis [4-hydroxy-2-nonenal (4-HNE)-positive, advanced glycation end products (AGEs), low-density lipoprotein receptor (LDL-R)-positive neurons, apolipoprotein E (ApoE)-positive senile plaque (SP), and insulin receptor (IR)-positive endothelium], and biochemistry analysis (adiponectin and leptin).

Results: The numbers of 4-HNE- and AGE-positive neurons and the sum of ApoE-positive SP size progressively increased with age in amyloid precursor protein (APP)-Tg mice, while the amount of IR-positive endothelium and the number of LDL-R-positive neurons decreased. Adiponectin and leptin serum levels were lower in APP-Tg mice than in non-Tg mice. Treatment with statins reduced the number of AGE-positive neurons from as early as 10 M, preserved the numbers of 4-HNE- and LDL-R-positive neurons and the amount of IR-positive endothelium at 15 M, and reduced the sum of ApoE-positive SP size and adiponectin serum level at 20 M.

Discussion: Atorvastatin and pitavastatin reduced the level of oxidative stress, as revealed by the presence of 4-HNE and AGE, in AD mouse brains, and that treatment with statins improves insulin signaling and LDL-R/ApoE systems. The beneficial effects of these statins may be associated with direct pleiotropic effects on AD mouse brains, indirect effects through improving the serum adiponectin/leptin balance, or both.     

阿托伐他汀对进展性脑卒中治疗作用的探讨

目的探讨他汀类药物对进展性脑卒中的治疗作用。方法对发病在48 h内的105例进展性脑卒中患者临床资料进行研究。入选病例分为他汀治疗组及对照组:对照组47例采用常规治疗,未予阿托伐他汀治疗;他汀治疗组58例,在常规治疗基础上,每晚睡前口服阿托伐他汀钙20 mg·d-1。两组患者治疗前和治疗后14d采用NIHSS评分评价神经功能缺损情况。结果他汀治疗组NIHSS评分改善显著优于对照组(P<0.0 5)。结论他汀类药物可提高进展性脑卒中患者的疗效。