早期应用两种剂量普伐他汀治疗急性冠脉综合征的临床研究

目的:探讨早期应用不同剂量的普伐他汀治疗急性冠脉综合征(ACS)的益处及安全性。方法:155例ACS患者随机单盲分为3组。对照组(A组):44例;10mg/d普伐他汀组(B组),55例;20mg/d普伐他汀组(C组),56例。随访1年,观察心脑血管事件,降脂效果及不良反应发生情况。结果:B、C组能显著降低血总胆固醇(TC)、甘油三酯(TG)及低密度脂蛋白(LDL)水平,升高血高密度脂蛋白(HDL);且C组疗效更优于B组(P<0.05)。B、C组复发性心绞痛(AP)、非致死性心肌梗死(MI)、心力衰竭(HF)和需做经皮腔内冠脉成形术/冠脉旁路移植术(PTCA/CABG)的病例均较对照组明显降低(P均<0.05),且C组的效果优于B组。B、C组C-反应蛋白(CRP)、纤维蛋白原(FIB)和D-二聚体均较A组显著降低(P均<0.05～0.01);且C组对上述3项的降低作用更优于B组(P均<0.05)。早期应用普伐他汀不良反应轻微,与对照组相似。结论:治疗ACS,早期应用普伐他汀20mg/d有效、安全,值得临床推广应用。

Clinical study of two different dose of Pravastatin in acute coronary syndrone

To explore the clinical effect and safety of pravastatin in acute coronary syndrome (ACS) with different doses. Methods: 155 cases were assigned three groups randomly. A group (n =44) as contol, B gronp (n =55) was treated with pravastatin 10mg per day; C group (n = 56) with pravastatin 20mg daily. All cases were followed up for 1 year. The level of blood lipid, c-reaction protein, fibrinogen, D-dimer were measured before and after treatment. Cardiocerebral events were monitored. Results: The level of total cholsterole (TC), triglyceride (TG), low dense lipoprotein (LDL) were significantly decreased in pravastatin B and C groups (P<0.01), and high dense lipoprotein (HDL) was significantly increased in both groups (P < 0.05). The cardiocerebral events such as reccured angina pectoris, fatal or nonfatal acute mycoar-dial infarction, heart failure and percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafty (CABG) were significantly lower in pravastatin B and C groups compared to the control(P< 0.05). And the effect was more significant in pravastatin 20mg/d group. CRP, FIB and D-dimer were significantly decreased in the groups treated with pravastatin (P<0.05-0.01). The adverse reactions were similar and mild in all groups. Conclusions: Pravastatin 20mg/d is safe and more effective in the treatment of acute coronary syndrome.