不同调脂方案对冠心病患者C反应蛋白和CD40配体的影响

目的 观察在冠状动脉狭窄50%～70%的冠心病患者中应用阿托伐他汀和依折麦布联合治疗调脂作用和安全性,及其对C-反应蛋白(CRP)、CD40配体(CD40L)的影响. 方法选取冠状动脉狭窄50%～70%的冠心病患者42例,均未植入支架,分为他汀组19例(40 mg阿托伐他汀)和联合治疗组(10 mg阿托伐他汀+10 mg依折麦布)23例.在服药前、用药4周、用药12周测定总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、肝功能、肾功能、肌酸激酶、CRP和CD40L. 结果 (1)他汀组和联合治疗组均在4周时患者的TC、LDL-C降低,12周时他汀组的LDL-C为(1.94±0.49)mmol/L,联合治疗组为(1.92±0.54)mmol/L,两组差异无统计学意义;(2)他汀组和联合治疗组患者肝功能、肾功能、肌酸激酶用药后无明显升高;(3)两组CRP在12周时较基线均有降低,他汀组CD40L降低. 结论单用他汀治疗和联合治疗降脂疗效无差异.两种治疗均未引起患者肝、肾功能和肌酸激酶异常.40 mg阿托伐他汀治疗可降低患者CRP、CD40L.

Effect of different uses of statins on C-reactive protein and CD40 liganol in patients with coronary heart disease

Objective To compare the efficacy and safety between atorvastatin alone and ezetimibe plus atorvastatin among patients with coronary heart disease (CHD) whose coronary artery stenosis were between 50%-70%, and to explore the effect of them on C reactive protein (CRP) and CD40 liganol. Methods A total of 42 CHD patients without stents were randomized into two groups: monotherapy group given 40 mg atorvastatin (n=19), combined therapy group given 10 mg atorvastatin plus 10 mg ezetimible (n=23). These patients continued their open-label administration for 12 weeks. And blood samples were collected at baseline, 4 weeks and 12 weeks after treatment. The levels of Cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol(HDL-C), liver and renal function, creatine kinase, CRP and CD40L were examined. Results At 4 weeks, TC and LDL-C were both reduced in monotherapy group and combined therapy group. At 12 weeks, there were no differences between monotherapy group and combined therapy group in LDL-C (1.94±0.49) mmol/L vs. (1.92±0.54) mmol/L, P>0.05]. The combined regimen was well tolerated, with a safety profile similar to 40 mg atorvastatin alone. The levels of CRP significantly decreased in both groups compared with baseline, and also CD40L decreased in monotherapy group. Conclusions Ezetimibecoadministered with 10 mg atorvastatin in CHD patients produce clinically important LDL-C reductions, with a profile similar to 40 mg atorvastatin. Both treatments are well tolerated. Monotherapy may be superior to combined-therapy in improving CD40 liganol.