急性心肌梗死应用阿托伐他汀强化治疗的临床研究

目的 探讨急性心肌梗死(AMI)患者早期应用阿托伐他汀40 mg/d的有效性及安全性.方法 对我院心内科冠心病监护病房2003年1月至2007年6月的1102例AMI患者于人院24 h内给予阿托伐他汀40 mg/d,患者平均住院(10.17±1.83)d.对出院时低密度脂蛋白胆固醇(LDL-C)<2.0 mmol/L,谷丙转氨酶(ALT)或谷草转氨酶(AST)升高超过正常值3倍以上的患者服用剂量减半,即阿托伐他汀20 mg/d,比较用药前、出院时及随访治疗期间血脂指标、高敏C反应蛋白(hs-CRP)及肝功能变化情况.结果 (1)治疗后总胆固醇(TC)、LDL-C和载脂蛋白B(ape B)比治疗前均有显著降低,差异具有统计学意义(P<0.05).其中LDL-C由(3.24±1.04)mmol/L下降至出院时的(2.27±2.00)mmol/L,随访3个月时进一步下降到(1.48±0.78)mmol/L;高密度脂蛋白胆固醇(HDL-C)由(1.45±0.38)mmol/L下降到出院时的(1.20±0.30)mmol/L至随访3个月时升至(1.65±1.79)mmol/L,各组间比较均P<0.05.(2)hs-CRP阿托伐他汀治疗前、出院时及随访1个月时分别为(49.71±50.46)mg/L、(8.80±17.66)mg/L和(2.61±2.30)mg/L,各组比较均P<0.05.(3)出院时ALT>120 U/L有124例(11.25%),AST>120 U/L有26例(2.4%).共502例患者返院随访复查.随访1个月时ALT>120 U/L仅为4例;随访3个月时无ALT>120 U/L的患者.结论 AMI患者早期应用阿托伐他汀40 mg/d治疗是有效和安全的.

Intensive atorvastatin therapy in patients with acute myocardial infarction

Objective To assess the safety and efficacy of 40 mg daily atorvastatin in patients with acute myocardial infarction.Methods A total of 1102 patients with AMI admitted to our hospital from 2003 to 2007 were assigned to atorvastatin 40 mg daily within 24 hours of hospitalization and continued till 3 months post discharge.Patients with LDL-C < 2.0 mmol/L or increased liver enzyme level (3 times higher than normal) at discharge received atorvastatin 20 mg daily.Lipid profiles, high-sensitivity C-reactive protein, liver enzyme level were measured at admission, hospital discharge and 3 months after discharge.Results ( 1 ) The mean hospitalization duration was ( 10.17 ± 1.83 ) days.LDL-C was continuously decreased [ (3.24 ± 1.04 ) mmol/L at admission, ( 2.27 ± 2.00 ) mmol/L at discharge and ( 1.48 ± 0.78) mmol/L at 3 months after discharge, all P < 0.05 ].HDL-C decreased from ( 1.45 ± 0.38 ) mmol/L to ( 1.20 ± 0.30) mmol/L at hospital discharge, then increased to ( 1.65 ± 1.79 ) mmol/L at 3 months after hospital discharge ( all P < 0.05 ) .TC and apoB were also significantly decreased from admission to discharge ( all P < 0.05 ).(2) high-sensitivity C-reactive protein level significantly decreased from admission to hospital discharge and at 1 months after hospital discharge[ (49.71±50.46)mg/L vs.( 8.80±17.66 ) mg/L vs.(2.61±2.30)mg/L, allP<0.05].(3) Increased ALT>120 U/L (3 times higher than normal) were found in 127 ( 11.25% ), AST > 120 U/L were found in 26 (2.40%) patients at discharge.There were still 4 patients with increased ALT ( > 120 U/L) at 1 months after discharge and all returned to normal at 3 months after discharge.conclusion Intensive atorvastatin therapy with a dose of 40 mg daily is safe and effective for patients with AMI.