不同剂量阿托伐他汀与辛伐他汀用于老年冠心病合并高脂血症治疗的临床效果比较

目的：对比不同剂量阿托伐他汀与辛伐他汀治疗老年冠心病合并高脂血症的临床疗效。方法选取肇庆市高要区人民医院心血管内科2013年5月至2015年4月期间收治的123例老年冠心病合并高脂血症患者，以数字表法随机分为观察A组、观察B组和对照组各41例，观察A组给予阿托伐他汀10 mg/d治疗，观察B组给予阿托伐他汀20 mg/d治疗，对照组给予辛伐他汀20 mg/d治疗，8周为一个疗程，三组均治疗3个疗程，比较三组患者治疗前后的总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平，以及治疗过程中的不良反应情况。结果治疗后观察A组、观察B组和对照组患者的TC分别为(3.94±0.49) mmol/L、(3.16±0.47) mmol/L、(4.04±0.48) mmol/L，TG分别为(1.54±0.39) mmol/L、(1.31±0.37) mmol/L、(1.55±0.40) mmol/L、LDL-C分别为(3.24±0.38) mmol/L、(2.93±0.39) mmol/L、(3.17±0.39) mmol/L，均显著低于治疗前的TC (5.93±0.54) mmol/L、(5.92±0.53) mmol/L、(5.95±0.52) mmol/L，TG (1.99±0.43)mmol/L、(1.97±0.41) mmol/L、(1.96±0.40) mmol/L，LDL-C (3.98±0.41) mmol/L、(3.95±0.42) mmol/L、(3.97±0.40) mmol/L，差异均有显著统计学意义(P<0.01)；治疗后观察A组、观察B组和对照组患者的HDL-C分别为(1.78±0.32) mmol/L、(1.75±0.34) mmol/L、(1.68±0.33) mmol/L，均显著高于治疗前的(1.06±0.34) mmol/L、(1.03±0.31) mmol/L、(1.04±0.33) mmol/L，差异均有显著统计学意义(P<0.01)；治疗后对照组HDL-C显著低于观察A、B两组，观察B组TC、TG、LDL-C均显著低于观察A组与对照组，HDL-C显著高于对照组，差异均有显著统计学意义(P<0.01)；观察B组患者的治疗有效率为95.1%(39/41)，明显高于观察A组的78.0%(32/41)和对照组的65.8%(27/41)，差异均有统计学意义(P<0.05或0.01)；三组不良反应发生率分别为4.9%，7.3%，2.4%，差异无统计学意义(P>0.05)。结论阿托伐他汀与辛伐他汀均能够有效降低冠心病合并高脂血症患者的血脂水平，但阿托伐他汀20 mg/d的临床疗效明显优于10 mg/d与辛伐他汀，安全有效，值得推广。

Comparison of the clinical effects of different doses of atorvastatin and simvastatin on elderly patients with coronary heart disease combined with hyperlipidemia

Objective To discuss the clinical effects of different doses of atorvastatin and simvastatin on elder-ly patients with coronary heart disease (CHD) combined with hyperlipidemia. Methods A total of 123 elderly patients with CHD combined with hyperlipidemia in Cardiovascular Medicine of Zhaoqing Gaoyao People's Hospital from May 2013 to April 2015 were selected and randomly divided into the observation group A (n=41), observation group B (n=41), and the control group. The observation group A and observation group B were treated with atorvastatin 10 mg/d and atorv-astatin 20 mg/d respectively, while the control group was treated with simvastatin 20 mg/d. The course of treatment was 8 weeks, and the patients were treated for 3 courses. The levels of total cholesterol (TC), triglyceride (TG), low density lipo-protein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C) and the adverse reactions were contrasted be-tween the three groups. Results After the treatment, TC, TG, LDL-C in the three groups were significantly lower than those before the treatment TC:(3.94±0.49) mmol/L vs (5.93±0.54) mmol/L, (3.16±0.47) mmol/L vs (5.92±0.53) mmol/L, (4.04 ± 0.48) mmol/L vs (5.95 ± 0.52) mmol/L;TG:(1.54 ± 0.39) mmol/L vs (1.99 ± 0.43) mmol/L, (1.31 ± 0.37) mmol/L vs (1.97 ± 0.41) mmol/L, (1.55 ± 0.40) mmol/L vs (1.96 ± 0.40) mmol/L;LDL-C (3.24 ± 0.38) mmol/L vs (3.98 ± 0.41) mmol/L, (2.93±0.39) mmol/L vs (3.95±0.42) mmol/L, (3.17±0.39) mmol/L vs (3.97±0.40) mmol/L;P<0.01]. After the treatment, the LDL-C levels in the three groups were significantly higher than those before the treatment (1.78±0.32) mmol/L vs (1.06± 0.34) mmol/L, (1.75 ± 0.34) mmol/L vs (1.03 ± 0.31) mmol/L, (1.68 ± 0.33) mmol/L vs (1.04 ± 0.33) mmol/L, P<0.01]. After treatment, the HDL-C in control group was significantly lower than that in the observation group A and observation group B. TC, TG, LDL-C in observation group B were significantly lower than those in observation group A and con-trol group, and the HDL-C in observation group B was significantly higher than control group (P<0.01). The effective rate of the observation group B was significantly higher than that in the observation group A and in the control group 95.1%(39/41) vs 78.0%(32/41), 65.8%(27/41), P<0.05 or P<0.01]. There was no significantly difference in the adverse reaction rate between the three groups (4.9%, 7.3%, 2.4%, P>0.05). Conclusion Atorvastatin and simvastatin can effec-tively reduce the lipid levels in elderly patients with coronary heart disease combined with hyperlipidemia, but the clini-cal efficacy of atorvastatin 20 mg/d is significantly better than atorvastatin 10 mg/d and simvastatin, which is safe, effec-tive and worthy of promotion.