PCI术后患者瑞舒伐他汀联合依折麦布的临床疗效观察
|
摘要
目的探讨经皮冠状动脉介入(PCI)术后不同降脂方案对血脂及安全性的影响。方法选取空军军医大学附属西京医院2018年1月～2018年7月拟行PCI的患者104例为研究对象,采用随机数字表法将其随机分为瑞舒伐他汀10 mg组(n=35),瑞舒伐他汀20 mg组(n=35)和瑞舒伐他汀10 mg+依折麦布组(联合用药组,n=34),随访6个月测定3组治疗前后血脂的变化水平,比较3组血脂达标率及用药不良反应发生情况。结果 3组患者治疗后总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、氧化低敏度脂蛋白胆固醇(oxLDL-C)、oxLDL-C/TC、oxLDL-C/LDL-C、oxLDL-C/HDL-C水平明显低于治疗前,差异有统计学意义(均P<0.05);联合用药组上述血脂指标降低幅度均大于瑞舒伐他汀10 mg组和20 mg组,差异有统计学意义(均P<0.05);联合用药组血脂达标率高于瑞舒伐他汀10 mg组和20 mg组,差异有统计学意义(均P<0.05);3组的不良反应发生率差异无统计学意义。结论 PCI术后瑞舒伐他汀联合依折麦布有较好的调脂效果、抗氧化作用,血脂达标率较高,且用药安全。
AIM To evaluate clinical efficacy and safety of different lipid-lowering regimens in patients after percutaneous coronary intervention(PCI). METHODS From January 2018 to July 2018, 104 patients with PCI planned were selected as study subjects and were randomly divided into a 10 mg rosuvastatin treatment group(n=35), a 20 mg rosuvastatin treatment group(n=35), and a 10 mg rosuvastatin +10 mg ezetimibe combined treatment group(n=34). The patients were followed up for six months. Serum lipids were measured before and after treatment and compliance rate and adverse drug reactions were compared between the three groups. RESULTS Levels of TC, LDL-C, oxLDL-C, oxLDL-C/TC, oxLDL-C/LDL-C and oxLDL-C/HDL-C were significantly lower than before in the three groups after treatment(P<0.05). The extent of reduction of TC and LDL-C in the combined 10 mg rosuvastatin+ezetimibe group was significantly larger than those in the 10 mg rosuvastatin and 20 mg rosuvastatin groups(P<0.05). The rate of attaining the standard of serum lipid in the combined 10 mg rosuvastatin+ezetimibe group was higher than those in the 10 mg rosuvastatin and 20 mg rosuvastatin groups, with statistically significant differences(P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the three groups(P<0.05). CONCLUSION The administration of rosuvastatin or the combined administration of rosuvastatin and ezetimibe in patients after percutaneous coronary intervention is safe and achieves beneficial effects in regulation of lipids and antioxidants and in attaining the standard of serum lipids.
AIM To evaluate clinical efficacy and safety of different lipid-lowering regimens in patients after percutaneous coronary intervention(PCI). METHODS From January 2018 to July 2018, 104 patients with PCI planned were selected as study subjects and were randomly divided into a 10 mg rosuvastatin treatment group(n=35), a 20 mg rosuvastatin treatment group(n=35), and a 10 mg rosuvastatin +10 mg ezetimibe combined treatment group(n=34). The patients were followed up for six months. Serum lipids were measured before and after treatment and compliance rate and adverse drug reactions were compared between the three groups. RESULTS Levels of TC, LDL-C, oxLDL-C, oxLDL-C/TC, oxLDL-C/LDL-C and oxLDL-C/HDL-C were significantly lower than before in the three groups after treatment(P<0.05). The extent of reduction of TC and LDL-C in the combined 10 mg rosuvastatin+ezetimibe group was significantly larger than those in the 10 mg rosuvastatin and 20 mg rosuvastatin groups(P<0.05). The rate of attaining the standard of serum lipid in the combined 10 mg rosuvastatin+ezetimibe group was higher than those in the 10 mg rosuvastatin and 20 mg rosuvastatin groups, with statistically significant differences(P<0.05). There was no statistically significant difference in the incidence of adverse reactions between the three groups(P<0.05). CONCLUSION The administration of rosuvastatin or the combined administration of rosuvastatin and ezetimibe in patients after percutaneous coronary intervention is safe and achieves beneficial effects in regulation of lipids and antioxidants and in attaining the standard of serum lipids.
引文
[1] 陈伟伟,高润霖,刘力生,等.《中国心血管病报告2017》概要[J].中国循环杂志,2018,33(1):1-8.
[2] 中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.
[3] 中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中华心血管病杂志,2016,44(10):833-853.
[4] Liao JK,Oesterle A.The pleiotropic effects of statins-from coronary artery disease and stroke to atrial fibrillation and ventricular tachyarrhythmia[J].Curr Vasc Pharmacol,2018,16:1-11
[5] Wilson P,Polonsky TS,Miedema MD,et al.Systematic Review for the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol:A report of the american college of cardiology/american heart association task force on clinical practice guidelines[J].J Am Coll Cardiol,2018,doi:10.1016/j.jacc.2018.11.004.
[6] Auer J,Weber T,Eber B.Intensive versus moderate lipid lowering with statins after acute coronary syndromes[J].N Engl J Med,2004,351(7):714-717.
[7] Nicholls SJ,Brandrup-Wognsen G,Palmer M,et al.Meta-analysis of comparative efficacy of increasing dose of Atorvastatin versus Rosuvastatin versus Simvastatin on lowering levels of atherogenic lipids (from VOYAGER)[J].Am J Cardiol,2010,105(1):69-76.
[8] Cannon CP,Blazing MA,Giugliano RP,et al.Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes[J].N Engl J Med,2015,372(25):2387-2397.
[9] Libby P,Ridker PM,Hansson GK.Progress and challenges in translating the biology of atherosclerosis[J].Nature,2011,473(7347):317-325.
[10]Alraies MC,Darmoch F,Tummala R,et al.Diagnosis and management challenges of in-stent restenosis in coronary arteries[J].World J Cardiol,2017,9(8):640-651.
[11]Margaritis M,Sanna F,Antoniades C.Statins and oxidative stress in the cardiovascular system[J].Curr Pharm Des,2017,23(46):7040-7047.
[12]Poh KK,Ambegaonkar B,Baxter CA,et al.Low-density lipoprotein cholesterol target attainment in patients with stable or acute coronary heart disease in the Asia-Pacific region:results from the Dyslipidemia International Study II[J].Eur J Prev Cardiol,2018,25(18):1950-1963.
[13]Burnett JR,Huff MW.Cholesterol absorption inhibitors as a therapeutic option for hypercholesterolaemia[J].Expert Opin Investig Drugs,2006,15(11):1337-1351.
[14]Nakano T,Inoue I,Takenaka Y,et al.Ezetimibe promotes brush border membrane-to-lumen cholesterol efflux in the small intestine[J].PLoS One,2016,11(3):e152207.
[15]Miura S,Saku K.Beneficial effects of ezetimibe-based therapy in patients with dyslipidemia[J].J Cardiol,2008,52(1):1-6.
[16]Rossebo AB,Pedersen TR,Boman K,et al.Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis[J].N Engl J Med,2008,359(13):1343-1356.
[17]Sharp CG.Study of Heart and Renal Protection (SHARP):randomized trial to assess the effects of lowering low-density lipoprotein cholesterol among 9,438 patients with chronic kidney disease[J].Am Heart J,2010,160(5):785-794.
[18]Kosoglou T,Statkevich P,Johnson-Levonas AO,et al.Ezetimibe:a review of its metabolism,pharmacokinetics and drug interactions[J].Clin Pharmacokinet,2005,44(5):467-494.
[19]Cicero A,Bove M,Borghi C.Pharmacokinetics,pharmacodynamics and clinical efficacy of non-statin treatments for hypercholesterolemia[J].Expert Opin Drug Metab Toxicol,2018,14(1):9-15.
[20]Lee S,Cannon CP.Combination Lipid-Lowering Therapies for the Prevention of Recurrent Cardiovascular Events[J].Curr Cardiol Rep,2018,20(7):55.
[21]Baigent C,Keech A,Kearney PM,et al.Efficacy and safety of cholesterol-lowering treatment:prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins[J].Lancet,2005,366(9493):1267-1278.
[22]Huang H,Ma R,Liu D,et al.Oxidized low-density lipoprotein cholesterol and the ratio in the diagnosis and evaluation of therapeutic effect in patients with coronary artery disease[J].Dis Markers,2012,33(6):295-302.
[23]Johnston N,Jernberg T,Lagerqvist B,et al.Improved identification of patients with coronary artery disease by the use of new lipid and lipoprotein biomarkers[J].Am J Cardiol,2006,97(5):640-645.
[2] 中华医学会心血管病学分会介入心脏病学组,中国医师协会心血管内科医师分会血栓防治专业委员会,中华心血管病杂志编辑委员会.中国经皮冠状动脉介入治疗指南(2016)[J].中华心血管病杂志,2016,44(5):382-400.
[3] 中国成人血脂异常防治指南修订联合委员会.中国成人血脂异常防治指南(2016年修订版)[J].中华心血管病杂志,2016,44(10):833-853.
[4] Liao JK,Oesterle A.The pleiotropic effects of statins-from coronary artery disease and stroke to atrial fibrillation and ventricular tachyarrhythmia[J].Curr Vasc Pharmacol,2018,16:1-11
[5] Wilson P,Polonsky TS,Miedema MD,et al.Systematic Review for the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the management of blood cholesterol:A report of the american college of cardiology/american heart association task force on clinical practice guidelines[J].J Am Coll Cardiol,2018,doi:10.1016/j.jacc.2018.11.004.
[6] Auer J,Weber T,Eber B.Intensive versus moderate lipid lowering with statins after acute coronary syndromes[J].N Engl J Med,2004,351(7):714-717.
[7] Nicholls SJ,Brandrup-Wognsen G,Palmer M,et al.Meta-analysis of comparative efficacy of increasing dose of Atorvastatin versus Rosuvastatin versus Simvastatin on lowering levels of atherogenic lipids (from VOYAGER)[J].Am J Cardiol,2010,105(1):69-76.
[8] Cannon CP,Blazing MA,Giugliano RP,et al.Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes[J].N Engl J Med,2015,372(25):2387-2397.
[9] Libby P,Ridker PM,Hansson GK.Progress and challenges in translating the biology of atherosclerosis[J].Nature,2011,473(7347):317-325.
[10]Alraies MC,Darmoch F,Tummala R,et al.Diagnosis and management challenges of in-stent restenosis in coronary arteries[J].World J Cardiol,2017,9(8):640-651.
[11]Margaritis M,Sanna F,Antoniades C.Statins and oxidative stress in the cardiovascular system[J].Curr Pharm Des,2017,23(46):7040-7047.
[12]Poh KK,Ambegaonkar B,Baxter CA,et al.Low-density lipoprotein cholesterol target attainment in patients with stable or acute coronary heart disease in the Asia-Pacific region:results from the Dyslipidemia International Study II[J].Eur J Prev Cardiol,2018,25(18):1950-1963.
[13]Burnett JR,Huff MW.Cholesterol absorption inhibitors as a therapeutic option for hypercholesterolaemia[J].Expert Opin Investig Drugs,2006,15(11):1337-1351.
[14]Nakano T,Inoue I,Takenaka Y,et al.Ezetimibe promotes brush border membrane-to-lumen cholesterol efflux in the small intestine[J].PLoS One,2016,11(3):e152207.
[15]Miura S,Saku K.Beneficial effects of ezetimibe-based therapy in patients with dyslipidemia[J].J Cardiol,2008,52(1):1-6.
[16]Rossebo AB,Pedersen TR,Boman K,et al.Intensive lipid lowering with simvastatin and ezetimibe in aortic stenosis[J].N Engl J Med,2008,359(13):1343-1356.
[17]Sharp CG.Study of Heart and Renal Protection (SHARP):randomized trial to assess the effects of lowering low-density lipoprotein cholesterol among 9,438 patients with chronic kidney disease[J].Am Heart J,2010,160(5):785-794.
[18]Kosoglou T,Statkevich P,Johnson-Levonas AO,et al.Ezetimibe:a review of its metabolism,pharmacokinetics and drug interactions[J].Clin Pharmacokinet,2005,44(5):467-494.
[19]Cicero A,Bove M,Borghi C.Pharmacokinetics,pharmacodynamics and clinical efficacy of non-statin treatments for hypercholesterolemia[J].Expert Opin Drug Metab Toxicol,2018,14(1):9-15.
[20]Lee S,Cannon CP.Combination Lipid-Lowering Therapies for the Prevention of Recurrent Cardiovascular Events[J].Curr Cardiol Rep,2018,20(7):55.
[21]Baigent C,Keech A,Kearney PM,et al.Efficacy and safety of cholesterol-lowering treatment:prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins[J].Lancet,2005,366(9493):1267-1278.
[22]Huang H,Ma R,Liu D,et al.Oxidized low-density lipoprotein cholesterol and the ratio in the diagnosis and evaluation of therapeutic effect in patients with coronary artery disease[J].Dis Markers,2012,33(6):295-302.
[23]Johnston N,Jernberg T,Lagerqvist B,et al.Improved identification of patients with coronary artery disease by the use of new lipid and lipoprotein biomarkers[J].Am J Cardiol,2006,97(5):640-645.