高敏C反应蛋白联合低密度脂蛋白胆固醇作为他汀治疗靶目标的临床研究

目的:探讨急性冠状动脉综合征(ACS)介入术后,以高敏C反应蛋白(hs-CRP)联合低密度脂蛋白胆固醇(LDL-C)作为他汀治疗靶目标的可行性。方法:2007-01-2009-01期间,连续纳入ACS患者400例,随机分为A、B组(每组200例),常规行介入手术,术后每组给予阿托伐他汀40mg/d,口服1个月;此后给予阿托伐他汀20mg/d,口服维持。A组治疗靶目标为LDL-C<2.07mmol/L,B组治疗靶目标为LDL-C<2.07mmol/L且hs-CRP<3mg/L,观察2组LDL-C、hs-CRP指标变化,随访6个月、12个月、18个月主要心血管不良事件(MACE:全因性死亡、非致死性心肌梗死、靶血管再次血运重建)。结果:2组患者基线特征差异无统计学意义;2组在18个月时均达到各自治疗靶目标;2组LDL-C水平差异无统计学意义;hs-CRP在12个月和18个月随访时差异有统计学意义,分别为(5.96±3.51)和(3.85±2.23)mg.L-1(P<0.05),(4.68±2.81)和(2.05±0.91)mg.L-1(P<0.05);在18个月随访时,2组靶血管再次血运重建率和MACE发生率差异有统计学意义,分别为8.6%和3.6%(P<0.05),16.8%和9.7%(P<0.05)。A组发生MACE的概率是B组的1.73倍(HR=1.73,95%CI:1.12～5.27,P=0.025)。结论:ACS介入术后,对于血脂已达标但炎症仍较为活跃患者,hs-CRP和LDL-C双重达标可进一步减少MACE发生,降低残余心血管风险。hs-CRP可能是他汀治疗的另一有效靶目标。

High-sensitivity C-reactive protein combined with low-densitylipoprotein cholesterol are the dual targets of statin therapy

Objective:To observe the efficiency of the treatment that high-sensitivity C-reactive protein(hs-CRP) combined with low-density lipoprotein cholesterol(LDL-C) were treated as the dual targets of statin therapy in patients with acute coronary syndrome(ACS). Method:From 2007 to 2009,400 patients with ACS were randomly divided into group A and group B.Both groups after percutaneous coronary intervention were treated with atorvastatin 40 mg/d for 1 month and then with atorvastatin 20 mg/d to maintain.The targets of group A are LDL-C<2.07 mmol/L and the targets of group B are LDL-C<2.07 mmol/L and hs-CRP<3 mg/L.We followed the MACE(the combined incidence of death,myocardial infarction and repeat revascularization) at 6,12 and 18 months after operation. Result:Two groups had similar baseline characteristics and achieved their different targets at 18 months.There was no difference in LDL-C,but a significant difference was found in hs-CRP at 12 months (5.96±3.51) vs(3.85±2.23)mg·L-1,P<0.05] and 18 months (4.68±2.81) vs(2.05±0.91)mg·L-1,P<0.05].There was a significant difference in repeat revascularization(8.6% vs 3.6%,P<0.05) and MACE(16.8% vs 9.7%,P<0.05) at 18 months.The probability of MACE in group A was 1.73 times that of in(delete) group B. Conclusion:Compared to LDL-C as the single target,the treatment of hs-CRP combined with LDL-C as the dual target of statin therapy in patients with ACS significantly reduced the incidence of MACE and residual cardiovascular risk,hs-CRP may be another target of statin therapy.