社区血脂异常患者他汀类药物使用情况调查研究

目的：对社区血脂异常患者他汀类药物的使用情况进行调查,并分析现状产生的原因。方法：选择2013年2月至2013年9月在社区卫生服务中心做血脂复查的患者124例,调查其使用他汀类药物的情况以及未服用他汀类药物患者不选择的原因,将服用他汀类药与未服用他汀类药的患者归为服用组与未服用组,比较两组患者的血脂水平。结果：124例患者中,30例患者使用他汀类药物,使用率为24．2％,58例患者（46．8％）使用其他药物进行治疗,另外36例（29．0％）患者未使用降脂药物;未服用他汀类的原因分析,知识缺乏有42例（44．7％）,医生处方原因28例（29．8％）,担心不良反应16例（17．0％）,经济原因有8例（8．5％）;服用组LDL、TG和 TC 水平均较未服用组明显降低, HDL水平较未服用组明显上升,差异具有统计学意义（ P＜0．05）。结论：社区血脂异常患者中他汀类药物的使用率明显偏低,且他汀类药物能明显改善血脂异常患者的血脂水平,未服用他汀类药物的主要原因是对他汀类相关知识不了解,社区医院应该加强对他汀类药物的推广。     

FK409类NO供体型他汀衍生物合成及活性评价

目的 合成系列FK409类NO供体型他汀衍生物并进行体外活性评价。方法 本文选用FK409类NO供体与阿托伐他汀、匹伐他汀及瑞舒伐他汀3种他汀药物分别通过酯化进行偶联。结果 设计合成了2个FK409类NO供体和6个该类NO供体型他汀衍生物。结论 通过体外活性测定,目标化合物具有良好的NO释放活性。     

Recommendations for the management of patients with homozygous familial hypercholesterolaemia: Overview of a new European Atherosclerosis Society consensus statement

Although homozygous familial hypercholesterolaemia (HoFH) is rare, patients with this disease have a poor prognosis, even when they receive the best available treatment, including pharmacotherapy and apheresis. The current therapeutic gap emphasizes the potential impact of new and developmental treatment options, which include lomitapide, mipomersen, anti-PCSK9 monoclonal antibodies and CETP inhibitors. It is imperative that patients with HoFH receive the most appropriate treatment as early as possible and clinical guidance is needed to provide clinicians with the information they require to expedite diagnosis and initiate effective treatment. Until now, however, guidance on the management of (HoFH) has generally been included as part of broader guidelines on dyslipidemia, FH or low-density lipoprotein (LDL)-apheresis and even in guidelines specifically on FH, HoFH has been under-represented. A consensus statement on recommendations for the management of HoFH has recently been published by a working group of the European Atherosclerosis Society. An outline of the content of the statement is presented in the current paper.     

Combination therapy in dyslipidemia: Where are we now?

Lowering low-density lipoprotein cholesterol (LDL-C) reduces the risk of cardiovascular disease: each 1.0 mmol/L (38.7 mg/dL) reduction in LDL-C reduces the incidence of major coronary events, coronary revascularizations, and ischemic stroke by approximately 20%. Statins are a well-established treatment option for dyslipidemia, with LDL-C reduction in the range of 27–55%.     

倍他乐克联合他汀类药物治疗颈动脉粥样硬化的疗效观察

目的观察倍他乐克联合他汀类药物在治疗颈动脉粥样硬化中的疗效及安全性。方法选取2011—2013年我院收治的颈动脉粥样硬化患者80例,将其随机分为试验组41例和对照组39例。对照组给予他汀类药物口服,试验组在对照组基础上给予倍他乐克片。以9个月为观察周期,观察两组患者C反应蛋白、同型半胱氨酸、血脂(TC、TG、LDL-C、HDL-C)、颈动脉内膜中层厚度(IMT)及颈动脉斑块平均大小,并记录其不良反应发生情况。结果治疗前两组C反应蛋白、同型半胱氨酸、血脂(TC、TG、LDL-C、HDL-C)、IMT及颈动脉斑块平均大小比较,差异无统计学意义(P0.05)。治疗后试验组C反应蛋白〔(2.23±1.87)mg/L〕、同型半胱氨酸〔(9.55±2.01)μmol/L〕、TC〔(4.88±1.56)mmol/L〕、TG〔(1.69±1.42)mmol/L〕、LDL-C〔(2.23±1.86)mmol/L〕低于对照组的〔(3.78±1.05)mg/L〕、〔(10.88±1.21)μmol/L〕、〔(5.31±1.23)mmol/L〕、〔(1.71±1.38)mmol/L〕、〔(2.35±1.43)mmol/L〕,IMT〔(0.88±0.54)mm〕及颈动脉斑块平均大小〔(0.38±0.32)mm〕小于对照组的〔(1.01±0.32)mm〕、〔(0.57±0.44)mm〕,HDL-C〔(1.23±0.36)mmol/L〕高于对照组的〔(1.20±0.21)mmol/L〕(P0.01)。试验组有2例患者出现明显心动过缓(心率50次/min),给予调整倍他乐克剂量后,症状缓解,继续服药。结论倍他乐克联合他汀类药物治疗颈动脉粥样硬化,可有效逆转斑块,减少心脑血管事件发生率,安全性好,值得推广。     

Simvastatin and fluvastatin reduce interleukin-6 and interleukin-8 lipopolysaccharide (LPS) stimulated production by isolated human monocytes from chronic kidney disease patients.

BACKGROUND: Statins reduce lipid levels, inflammation and cardiovascular events in patients with coronary artery disease; CKD patients show increased risk of cardiovascular and increased plasma levels of IL-6 and IL-8. AIM: To evaluate the in vitro effect of simvastatin (S) or fluvastatin (F) on the lipopolysaccharide (LPS) stimulated secretion of IL-6 and IL-8 from monocytes of chronic kidney disease patients (CKD) in K-DOQI stages 3-5. METHODS AND SUBJECTS: Monocytes enriched peripheral blood (PBMC) from 28 CKD (15 in K-DOQI stages 3-4, Group I, and 13 in K-DOQI stage 5 on hemodialysis, Group II) and 10 healthy subjects (HS), were isolated by Ficoll-gradient centrifugation. Cells were incubated with LPS 100 ng/ml or with LPS plus increasing doses of statins (from 10(-6) to 10(-8) M ) for 24 h. Surnatant IL-6 and IL-8 concentrations were determined by EIA. RESULTS: Basally the mean concentration of IL-6 and IL-8 was higher in patients than in HS and in Group II than in Group I (IL6: HS 285 +/- 77 pg/ml, Group I 365 +/- 178 pg/ml, Group II 520 +/- 139 pg/ml- IL8 HS 180 +/- 75 pg/ml, Group I 1722 +/- 582 pg/ml, Group II 4400 +/- 1935 pg/ml). After addition of LPS the mean concentration of IL-6 and IL-8 increased in all groups (IL6: HS 1740 +/- 178 pg/ml, Group I 3754 +/- 672 pg/ml, Group II 4800 +/- 967 pg/ml; IL8: HS 450+/-132 pg/ml, Group I 9700+/-2837 pg/ml, Group II 11608 +/- 2316 pg/ml). After the addition of LPS plus increasing doses of S or F from 10(-10) to 10(-6) M, a significantly lower cytokine concentration compared to the data after LPS alone was observed (IL6: HS 45%, Group I 75%, Group II 50%; IL8: HS 100%, Group I 65%, Group II 35%). CONCLUSIONS: These data confirm that cytokine release is increased in CKD patients and that is highest in the most severe patients. Furthermore they suggest that fluvastatin or simvastatin can be used in order to reduce the high cardiovascular risk.     

他汀药物治疗对尿毒症患者微炎症反应的影响

目的探讨他汀药物治疗对尿毒症患者微炎症反应的影响。方法选择重庆市第三军医大学新桥医院肾内科终末期肾病患者(ESRD)55例,随机分为对照组和他汀治疗组,另选择20例正常人作为正常对照,监测治疗前后患者炎症因子的变化。结果与正常人组比较,治疗前尿毒症患者的炎症因子C反应蛋白(CRP)、白介素-1(IL-1)、白介素-6(IL-6)、肿瘤坏死因子α(TNFα)水平均显著升高,而营养学指标(血浆白蛋白、血浆前白蛋白、血红蛋白)含量均显著降低。来适可20mg治疗4月,虽然治疗组患者血脂、血糖无明显改变,但CRP、IL-1、IL-6、TNF-α含量明显减少,血浆白蛋白、血浆前白蛋白、血红蛋白明显升高,同时患者肌酐尿素氮含量也呈下降趋势。结论他汀治疗可以显著抑制尿毒症患者微炎症反应、改善营养状态。     

他汀类药物治疗对胆固醇不高的冠心病患者血管重建术的影响

目的 观察住院期间应用他汀类药物对低密度脂蛋白胆固醇（LDL-C）〈2．6mmol／L的冠心病患者血管重建术后住院和随访结果的影响。方法 我院接受血管重建治疗并且LDL—C〈2．6mmol／L的患者1765例，根据住院期间是否应用他汀类药物分为他汀组1056例与非他汀组709例。结果 他汀组院内主要不良心脑血管事件（MACCE）发生率和随访病死率均较非他汀组明显降低（分别为1．7％比3．8％，P=0．006；2．1％比5．1％，P=0．002），他汀组血管重建后累积病死率（院内及随访）也明显低于非他汀组（3．6％比7．9％，P〈0．001）。经logistic多因素回归分析，住院期间是否应用他汀类药物与累积病死率（院内死亡和随访死亡）显著相关（RR：0．597；95％CI为0．360～0．990；P=0．046），并且与随访病死率显著相关（RR：0．436；95％CI为0．231～0．821；P=0．01）。结论 住院期间应用他汀类药物可以显著减少胆固醇不高的冠心病患者血管重建术后的住院不良事件，降低累积病死率及随访病死率。     

Statin use and knee osteoarthritis progression: Results from a post-hoc analysis of the SEKOIA trial

Objective

Epidemiological and experimental studies have suggested that lipid disorders might be involved in the pathophysiology of knee osteoarthritis (OA). Studies assessing the effect of statins on knee OA progression have shown conflicting results. We investigated the impact of statin use on radiological progression in patients with radiological and symptomatic knee OA.