摘要
目的:评价依折麦布10mg/天联合普伐他汀20mg /天在急性冠脉综合征患者中的降脂疗效,及其对高敏C反应蛋白的影响。方法:急性冠脉综合征患者80例,随机分为观察组42例,普伐他汀20mg /天联合依折麦布10mg /天;对照组38例,普伐他汀20mg /天,治疗30天。检测所有患者入院后0天、第7天、第30天血脂、高敏C反应蛋白。两组治疗前后组内以及组间进行对比分析。结果:治疗第7天、与基线水平比较两组TC、LDL-C、ApoB均明显降低(P<0.001),观察组TG明显降低(P<0.01);治疗30天后与基线水平比较两组TC、LDL-C均进一步降低,对照组ApoB未继续变化,观察组进一步降低,两组TG进一步降低(P<0.01),观察组VLDL出现了明显降低(P<0.05),对照组HDL-C、ApoA1明显升高(P<0.05)。治疗第7天两组间比较,TC(-18.2%vs-16.3% P<0.05)、LDL-C(-27.2% vs -24.6% P<0.05)降幅观察组比对照组更明显;第30天两组TC(-30.8%vs-22.5% P<0.001)、LDL-C(-44.1% vs -31.9% P<0.001)降幅之间的差异更显著,另外ApoB(-23.1% vs -19.1% P<0.05)的降幅两组也有差异;尽管在治疗后第30天时,观察组比对照组在TG、HDL-C、VLDL、VLDL、Lp(a)均有进一步的改善,但未产生有意义的差异。无论是按LDL-C<2.07mmol/L的标准还是LDL-C<1.8mmol/L的标准,第30天达标率观察组均明显优于对照组(69%vs28.9% P<0.05)和(47.6%vs13.2% P<0.05)。治疗第7天与基线水平比较两组hs-CRP均明显降低(P<0.01),第30天降低更明显(P<0.001);两组间比较在第7天差异不显著,第30天时产生了显著差异(1.20(1.85)vs2.25(2.65) P<0.05),观察组降低更显著。两组在治疗过程中均未出现肝毒性、肌病等不良反应。结论:对于急性冠脉综合征患者,依折麦布10mg/天联合普伐他汀20mg /天比普伐他汀20mg/天具有更好的降低LDL-C、TC的疗效,使更多的患者LDL-C达标,并且具有更好的抗炎症反应的效果。
Objective: To evaluate lipid-lowering effects of pravastatin20 mg coadministration with ezetimibe 10mg in patients with acute coronary syndrome. and the change on high sensitivie C-reactive protein. Methods: 80 patients with acute coronary syndrome were divided randomly into two groups:observed group in 42 coadministrated pravastatin20 mg with ezetimibe 10 mg daily, control group in 38 administrated with pravastatin 20 mg daily in 30 days. detected their lipid and high sensitivie C-reactive protein at day 0, days7 and days 30. Comparative Analysis were made after treatment in and between groups. Results: When compared with baseline,TC, LDL-C and ApoB decreased significantly in all two groups at days 7(P<0.001), TG only decreased significantly in observed group (P<0.01); TC,LDL-C and TG decreased further in all two groups at days 30(P<0.01), but ApoB kept no changed in control group, while decreased further in observed group, VLDL produced significant decrease in observed groups(P<0.05), HDL-C、ApoA1 elevated significantly in control group(P<0.05). When compared between two groups, observed group produced greater reduction than control group at days 7 in TC(-30.8%vs-22.5% P<0.001),LDL-C(-44.1% vs -31.9% P<0.001), and the difference was more significant after 30 days, TC(-30.8%vs-22.5% P<0.001), LDL-C(-44.1% vs -31.9% P<0.001); and there was difference between two groups in reducation of ApoB(-23.1% vs -19.1% P<0.05); TG,HDL-C,VLDL,VLDL and Lp(a) had improved at days 30 in all groups, but hadn’t produce significant difference, in term of either chinese guidelines on prevention and treatment of dyslipidemia in adults goal LDL-C<2.07mmol/L or NCEP ATPⅢgoal LDL-C<1.8mmol/L, observed group had more reduction than control group after at days 30 (69%vs28.9% P<0.05) and (47.6%vs13.2% P<0.05). When compared with baseline, hs-CRP reduced in all two groups at days 7(P<0.01), and got further reduction in days 30 (P<0.001); there was no difference between two groups at days 7, but produced significant difference in at days 30 (1.20(1.85)vs2.25(2.65) P<0.05), observed group had more reduction. No adverse effect of hepatotoxicity or myopathy in all two groups in trial. Conclusion: When treatment of patients with acute coronary syndrome, coadministration pravastatin 20mg with ezetimibe 10mg is superior to pravastatin 20mg alone in lowering LDL-C,TC, allow more patients reached LDL-C goal, and has better anti-inflammation effects.
引文
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