阿托伐他汀40mg在急性冠脉综合征介入术后的应用

目的:观察阿托伐他汀40 mg·d~(-1)在急性冠脉综合征(ACS)介入术后强化降脂治疗的不良反应和调脂疗效。方法:120例ACS病人,在进行经皮冠脉介入治疗术后,随机分为A组(阿托伐他汀10 mg·d~(-1))和B组(阿托伐他汀40 mg·d~(-1))各60例。观察2组病人用药后的不良反应,分别在用药前,用药后1、4、12、24 wk检测肝、肾功能,心肌酶,血脂水平,比较2组情况。结果:2组病人用药后1～4 wk为丙氨酸转氨酶(ALT)出现异常的高峰期,1 wk时B组ALT异常48%,A组ALT异常25%,2组有显著差异(P＜0．05),ALT升高多数＜3倍正常值,不需停药,观察后恢复正常;而A组有7%、B组有5%的病人ALT＞3倍,需停药,2组比较无显著差异。很少胃肠反应、精神症状,B组有1例肾功能异常,无肌病。给药后12、24 wk后2组总胆固醇、低密度脂蛋白(LDL)下降幅度均有显著差异(P＜0．05), 2组服药后4、12、24 wk的LDL≤1．8 mmol·L~(-1)百分数比较均有显著差异(P＜0．05)。结论:使用40 mg·d~(-1)阿托伐他汀除早期ALT轻度升高增加外,其他不良反应无明显增加;降低总胆固醇、低密度脂蛋白效果与剂量相关。

Application of atorvastatin in acute coronary artery syndromes patients after percutaneous coronary intervention

AIM:To observe the adverse reactions and clinical effect of intensive lipid-lowing therapy with atorvastatin(40 mg·d~(-1))in acute coronary artery syndromes(ACS)patients after percutaneous coronary intervention(PCI).METHODS :ACS patients(n=120)after PCI were randomized into two groups,group A(atorvastatin 10 mg·d~(-1))and group B(atorvastatin 40 mg·d~(-1)).Alanine aminotransferase(ALT),creatinine (Cr)and blood lipid were tested before administration and after 1,4,12,24 wk to observe the digestion reaction and the psychiatric symptom.RESULTS:The ALT peak of both group was at wk 1-4,and the ALT abnormality were 25% in group A and 48% in group B at the first week,there were significant difference between two group(P＜0.05).Most of the ALT abnormality were less than 3 times of the normal value and needn't withdrawal,but 7% in group A and 5% in group B were more than 3 times of the normal value and need discontinuation,there were no significant difference between two group.There was only 1 patient with renal fimction abnormality in group B,and there was no rhabdomyolysis.The level of cholesterol(TC)and low density lipoprotein(LDL)of 12 weeks and 24 weeks were statistically significant between two groups(P＜0.05).There were also statistically significant of the percentage of LDL≤1.8 mmol·L~(-1)at 4,12 and 24 wk after administration between two groups(P＜0.05).CONCLUSION:The adverse reactions of atorvastatin 40 mg·d~(-1)is mild and similar to 10 mg·d~(-1),and atorvastatin 40 mg·d~(-1)is safe in Chinese ACS patients after PCI.The efficacy of lowering TC and LDL is associated with dosage.