不同降血脂药物预防冠状动脉搭桥术后桥血管再次狭窄疗效观察

目的比较辛伐他汀、阿托伐他汀钙和瑞舒伐他汀钙预防冠状动脉搭桥术(CABG)后桥血管再次狭窄的临床疗效。方法 143例行CABG患者分为辛伐他汀组48例、阿托伐他汀钙组50例和瑞舒伐他汀钙组45例。术后第1天和1 a,检测患者血清中高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)和脂蛋白磷脂酶A2(Lp-PLA2)水平;1 a后随访时行冠状动脉造影。比较3组患者血脂水平、桥血管狭窄直径比例和踝臂指数。结果用药1 a后,3组患者血管狭窄比例均低于50.0%,踝臂指数均在正常值范围。阿托伐他汀钙组血管狭窄比例和踝臂指数显著低于辛伐他汀组和瑞舒伐他汀钙组(P<0.05),瑞舒伐他汀钙组血管狭窄比例和踝臂指数显著低于辛伐他汀组(P<0.05)。术后第1天,3组患者血清HDL-C、LDL-C和Lp-PLA2水平比较差异无统计学意义(P>0.05)。服用降血脂药物1 a后,3组患者血清HDL-C水平均显著高于术后第1天(P<0.05),LDL-C和Lp-PLA2水平均显著低于术后第1天(P<0.05);阿托伐他汀钙组患者HDL-C水平显著高于辛伐他汀组和瑞舒伐他汀钙组(P<0.05),LDL-C和Lp-PLA2水平显著低于辛伐他汀组和瑞舒伐他汀钙组(P<0.05)。结论 3种药物均可有效调节冠状动脉粥样硬化性心脏病患者血脂水平,并可有效预防CABG后桥血管再狭窄,尤以阿托伐他汀钙效果更好。

Preventive effects of different lipid-lowering drugs on the restenosis of graft after coronary artery bypass graft

Objective To compare the preventive effects of simvastatin,atorvastatin calcium and rosuvastatin calcium on the restenosis of graft after coronary artery bypass graft(CABG).Methods One hundred and forty-three patients who received CABG were divided into simvastatin group(n=48),atorvastatin calcium group(n=50) and rosuvastatin calcium group(n=45).One day and one year after CABG,the levels of serum high density lipoprotein-cholesterol(HDL-C),low density lipoprotein-cholesterol(LDL-C) and lipoprotein-phospholipase A2(Lp-PLA2) were detected.Coronary arteriongraphy was performed after one year follow-up.The serum lipid levels,vascular stenosis proportion and ankle-brachial index were compared in the three groups.Results One year after medication,the vascular stenosis proportions were less than fifty percent,and the ankle-brachial indices were within normal range in the three groups.The vascular stenosis proportion and ankle-brachial index in atorvastatin calcium group were significantly lower than those in simvastatin group and rosuvastatin calcium group(P<0.05),and the vascular stenosis proportion and ankle-brachial index in rosuvastatin calcium group were significantly lower than those in simvastatin group(P<0.05).One day after CABG,there was no statistical difference in the levels of HDL-C,LDL-C and Lp-PLA2 in the three groups(P>0.05).One year after medication,the levels of serum HDL-C in three groups were significantly higher than those at the first day after CABG(P<0.05),and the levels of serum LDL-C and Lp-PLA2 were significantly lower than those at the first day after CABG(P<0.05).One year after medication,the level of HDL-C in atorvastatin calcium group was significantly higher than that in simvastatin group and rosuvastatin calcium group(P<0.05),and the levels of serum LDL-C and Lp-PLA2 in atorvastatin calcium group were significantly lower than those in simvastatin group and rosuvastatin calcium group(P<0.05).Conclusions Three kinds of drugs can effectively regulate serum lipid levels in patients with coronary atherosclerotic herat disease,and can effectively prevent the restenosis of graft after CABG effectively,especially atorvastatin calcium is better.