氟伐他汀对胆固醇正常的冠心病患者血脂、血液流变学及心肌缺血影响的观察

目的 观察氟伐他汀对血清胆固醇正常水平的冠心病患者血脂、血液流变学及心肌缺血的影响.方法 68例冠心病,其空腹血清总胆醇为4.71～5.69mmol/L(181～219mg/dl),随机分为2组.常规治疗为服消心痛每日3次,每次10mg,美托洛尔每日2次,每次12.5mg,阿司匹林每日50mg.其中35例(氟伐他汀组)在常规治疗基础上,加用氟伐他汀钠(来适可),每晚40mg.以3个月为1个疗程,连续服药2个疗程(6个月).常规治疗组33例,不用氟伐他汀,其治疗方法与疗程均与氟伐他汀组相同.每疗程开始前1d与结束次日,进行血脂、血液流变学与动态心电图(DCG)检测.结果 服氟伐他汀3个月,查血脂示TC、LDL-C明显下降(P＜0.01),TG、HDL-C无变化(P＞0.05).用药6个月TG、LDL-C进一步降低(P＜0.01),HDL-C亦上升(P＜0.05).TG虽有下降趋势,但未达到统计学显著性程度(P＞0.05).常规治疗组TC、TG、LDL-C、HDL-C治疗前后差异均不显著(P＞0.05).血液流变学观察,患者经氟伐他汀治疗后(3、6个月),示低切变率下全血黏度、高切变率下全血黏度、血浆比黏度、血小板聚集率、纤维蛋白原均显著下降(P＜0.05),与常规治疗组比较,其差异亦有显著性(P＜0.05).DCG监测示用药3个月时,两组的症状性与无症状ST段压低次数及其持续时间均减少(P均＜0.05),但两组间无差异(P＞0.05).用药6个月示氟伐他汀组症状性与无症状的ST段压低次数及其持续时间进一步减少(P＜0.01),与常规治疗组比较亦有显著差异(P＜0.05).在随访治疗过程中发现常规治疗组有1例发生急性下壁心肌梗死而住院治疗;氟伐他汀组无1例发生心血管事件,病情均稳定,且未见氟伐他汀严重不良反应.结论 氟伐他汀有调脂与改善血液流变性作用,长程治疗胆固醇正常的冠心病患者,有助于减少心肌缺血的发作和改善预后.

Effects of fluvastatin on blood lipid, hemorrheology and myocardial ischemia in patients of normocholesterolemia with coronary artery disease

Objective To observe effects of fluvastatin(Flu)on blood lipid,hemorrheology and myocardial ischemia in patients of normocholesterolemia with coronary artery disease(NCAD).Methods Sixty-eight cases of NCAD were divided randomly into Flu group(35 cases)and routine group(33 cases).The Flu group were treated with fluvastaion based on normal treatment,the routine group were treated by aspirin,metolol and sorbitrate.Both groups were treated for consecutive 6 months.Blood lipids and hemorrheology were measured,and myocardial ischemia was assessed by dynamicelectrocardiogram before and after treatment.Results After 3 months,the levels of TC,LDL-C in Flu group were reduced significantly(P<0.01),but the level of HDL-C was increased(P<0.05).After 6 months,the level of TG was not significantly decreased(P>0.05),while in routine group,the levels of TC,TG,HDL-C and LDL-C were not significant differential(P>0.05)between before and after treatment.Whole blood viscosity under low or high shear rate,plasma viscosity,platelet agglutinate rate and fibrinogen in the Flu group after treatment were reduced(P<0.05),and the differences were significant(P<0.05)between two groups.The freguency and continuative time of symptomatic and asymptomatic myocardial ischemia were reduced(P<0.05)in each group after 3 months,but there were no significantly differences(P>0.05)between two groups.Moreover,after 6 months,the efficacy in Flu group was better(P<0.05)than that in routine group.In the Flu group,there was no fatal events and severe adverse effect.Conclusion Fluvastatin can adjust the blood lipids,and improve the conditions of hemorrheology.It is helpful for reducing the ocurrence of myocardial ischemia for NCAD and improving it's progonosis.