他汀类药物治疗年龄大于80岁老年血脂异常患者的效果
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摘要
目的探讨他汀类药物在年龄>80岁的血脂异常老年人群中临床应用的获益情况及安全性,从而为老年人群临床应用他汀类药物提供依据。方法选取2014年8月～2017年5月在编的年龄>80岁且血脂异常的上海市黄浦区离休干部80例,采用随机数字表法分为对照组和研究组,各40例。对照组予血脂宣教、低脂饮食、适当运动;研究组在对照组治疗方案基础上,每晚口服40 mg普伐他汀。随访6个月血脂、肝肾功能、肌酶、炎症因子变化情况并进行分析。结果对照组治疗后总胆固醇和尿酸水平均明显低于治疗前,差异有统计学意义(P <0.05)。研究组治疗后总胆固醇、低密度脂蛋白胆固醇、肿瘤坏死因子、白介素-6水平均明显低于治疗前,差异有统计学意义(P <0.05)。治疗后,研究组总胆固醇水平低于对照组,差异有统计学意义(P <0.05)。结论普伐他汀应用于年龄>80岁的人群,可显著降脂、减少炎症因子等,对于肝肾功能、肌酶、心室功能等方面无明显副作用。
Objective To investigate the benefit and safety situation of statins delivered to the elder people over 80 years old with dyslipidemia in clinical practice, and consequently provide guideline for the statins therapy applied to the elder people. Methods A total of 80 cases of the registered retired officers over 80 years old from August 2014 to Mag 2017 in Huangpu District, Shanghai, with dyslipidemia were selected. According to the random number table method, all the cases were divided into control group and study group, with 40 cases in each group. The control group was given blood lipid knowledge education, low fat diet and proper physical practice; the study group was given 40 mg/d Pravastatin po qn on the basis of the therapy of the control group. The two groups were followed up for 6 months about blood lipid, hepatorenal function, myocardial enzyme and inflammatory factor and analysis was performed. Results After treatment, the total cholesterol and uric acid level of the control group significantly reduced compared with those before treatment, and the difference was significant(P < 0.05). After treatment, the total cholesterol, low density lipoproteincholesterol, tumor necrosis factor and interleukins-6 levels significantly reduced compared with those before treatment,and the difference was significant(P < 0.05). After treatment, the total cholesterol level of the study group was significantly lower than the control group, and the difference was significant(P < 0.05). Conclusion Applying to elder people over 80 years old, Pravastatin can reduce blood lipid and inflammatory factor, meanwhile it has no obvious side effects on hepatorenal function, creatase and ventricular function.
Objective To investigate the benefit and safety situation of statins delivered to the elder people over 80 years old with dyslipidemia in clinical practice, and consequently provide guideline for the statins therapy applied to the elder people. Methods A total of 80 cases of the registered retired officers over 80 years old from August 2014 to Mag 2017 in Huangpu District, Shanghai, with dyslipidemia were selected. According to the random number table method, all the cases were divided into control group and study group, with 40 cases in each group. The control group was given blood lipid knowledge education, low fat diet and proper physical practice; the study group was given 40 mg/d Pravastatin po qn on the basis of the therapy of the control group. The two groups were followed up for 6 months about blood lipid, hepatorenal function, myocardial enzyme and inflammatory factor and analysis was performed. Results After treatment, the total cholesterol and uric acid level of the control group significantly reduced compared with those before treatment, and the difference was significant(P < 0.05). After treatment, the total cholesterol, low density lipoproteincholesterol, tumor necrosis factor and interleukins-6 levels significantly reduced compared with those before treatment,and the difference was significant(P < 0.05). After treatment, the total cholesterol level of the study group was significantly lower than the control group, and the difference was significant(P < 0.05). Conclusion Applying to elder people over 80 years old, Pravastatin can reduce blood lipid and inflammatory factor, meanwhile it has no obvious side effects on hepatorenal function, creatase and ventricular function.
引文
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[9]Navar-Boggan AM,Peterson ED,D′Agostino RB Sr,et al.Hyperlipidemia in early adulthood increases long-term risk of coronary heart disease[J].Circulation,2015,13(5):451-458.
[10]Pilote L,Beck CA,Karp I,et al.Secondary prevention after acute myocardial infarction in four Canadian provinces,1997-2000[J].Can J Cardiol,2004,20(1):61-67.
[11]方晓霞,陈俊,何国厚.他汀类药物对急性缺血性脑卒中患者循环内皮祖细胞水平的影响[J].中国医药导报,2013,10(33):97-100.
[12]周长武,李澄,赵锡海,等.磁共振管壁成像观察他汀类药物对老年人胸主动脉粥样硬化斑块特征的影响[J].中华老年医学杂志,2017,36(4):412-416.
[13]贾书杰,齐琳,史凯蕾,等.多层螺旋CT评价他汀类药物对冠状动脉非钙化斑块的疗效[J].中国医学影像学杂志,2016,24(7):500-503.
[14]楚罗湘,周素娴,杨帆,等.普伐他汀和CRP对ADP诱导的血小板凝血酶受体PAR-1表达的调节[J].重庆医学,2016,45(11):1459-1462.
[15]雷锐.不同剂量他汀类药物对早期急性心肌梗死的临床效果和安全性分析[J].中西医结合心脑血管病杂志,2017,15(9):1078-1080.
[16]何洪,李坤浪,钟伟章.他汀类药物治疗慢性心力衰竭的应用价值[J].中国医药导报,2015,12(33):151-154.
[17]邹茵,朱金晓,殷治国.戒烟对重度牙周炎病人血脂以及炎症因子的影响[J].实用老年医学,2017,31(10):978-981.
[18]林新杰,肖新华.胆固醇、他汀类药物与帕金森病关系的研究进展[J].中华老年多器官疾病杂志,2017,16(6):464-467.
[19]谷祥任,张雁.不同浓度的普伐他汀对小鼠巨噬细胞极性的影响研究[J].重庆医学,2016,45(9):1173-1178
[20]Heart Protection Study Collaborative Group.MRC/BHFHeart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals:a randomized placebo-controlled trial[J].Lancet,2002,360(9326):7-22.
[21]The Long-term Intervention with Pravastatin in Ischemic Disease(LIPID)Study Group.Prevention of cardiovascular events and deaths with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels[J].N Engl J Med,1998,339:1349-1357.
[2]叶平.老年人血脂异常的治疗策略[J].中华老年多器官疾病杂志,2015,14(8):569-572.
[3]血脂异常老年人使用他汀类药物中国专家共识组.血脂异常老年人使用他汀类药物中国专家共识[J].中华内科杂志,2015,54(5):467-477.
[4]仝其广,胡大一.他汀类药物的安全性问题[J].中国实用内科杂志,2007,27(9):655-657.
[5]Al-Omran M,Mamdani MM,Lindsay TF,et al.Suboptimal use of statin therapy in elderly patients with atherosclerosis:a population-based study[J].J Vasc Surg,2008,48(3):607-612.
[6]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].中国循环杂志,2016,31(10):937-950.
[7]Yang G,Wang Y,Zeng Y,et al.Rapid health transition in China,1990-2010:findings from the Global Burden of Disease Study 2010[J].Lancet,2013,381(9882):1987-2015.
[8]阮磊,吴晓芬,张存泰.老年血脂异常病人人体成分与血脂的相关性研究[J].实用老年医学,2017,31(10):966-968.
[9]Navar-Boggan AM,Peterson ED,D′Agostino RB Sr,et al.Hyperlipidemia in early adulthood increases long-term risk of coronary heart disease[J].Circulation,2015,13(5):451-458.
[10]Pilote L,Beck CA,Karp I,et al.Secondary prevention after acute myocardial infarction in four Canadian provinces,1997-2000[J].Can J Cardiol,2004,20(1):61-67.
[11]方晓霞,陈俊,何国厚.他汀类药物对急性缺血性脑卒中患者循环内皮祖细胞水平的影响[J].中国医药导报,2013,10(33):97-100.
[12]周长武,李澄,赵锡海,等.磁共振管壁成像观察他汀类药物对老年人胸主动脉粥样硬化斑块特征的影响[J].中华老年医学杂志,2017,36(4):412-416.
[13]贾书杰,齐琳,史凯蕾,等.多层螺旋CT评价他汀类药物对冠状动脉非钙化斑块的疗效[J].中国医学影像学杂志,2016,24(7):500-503.
[14]楚罗湘,周素娴,杨帆,等.普伐他汀和CRP对ADP诱导的血小板凝血酶受体PAR-1表达的调节[J].重庆医学,2016,45(11):1459-1462.
[15]雷锐.不同剂量他汀类药物对早期急性心肌梗死的临床效果和安全性分析[J].中西医结合心脑血管病杂志,2017,15(9):1078-1080.
[16]何洪,李坤浪,钟伟章.他汀类药物治疗慢性心力衰竭的应用价值[J].中国医药导报,2015,12(33):151-154.
[17]邹茵,朱金晓,殷治国.戒烟对重度牙周炎病人血脂以及炎症因子的影响[J].实用老年医学,2017,31(10):978-981.
[18]林新杰,肖新华.胆固醇、他汀类药物与帕金森病关系的研究进展[J].中华老年多器官疾病杂志,2017,16(6):464-467.
[19]谷祥任,张雁.不同浓度的普伐他汀对小鼠巨噬细胞极性的影响研究[J].重庆医学,2016,45(9):1173-1178
[20]Heart Protection Study Collaborative Group.MRC/BHFHeart Protection Study of cholesterol lowering with simvastatin in 20536 high-risk individuals:a randomized placebo-controlled trial[J].Lancet,2002,360(9326):7-22.
[21]The Long-term Intervention with Pravastatin in Ischemic Disease(LIPID)Study Group.Prevention of cardiovascular events and deaths with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels[J].N Engl J Med,1998,339:1349-1357.
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