阿托伐他汀联合依折麦布治疗老年稳定型心绞痛疗效观察
摘要
目的:观察阿托伐他汀联合依折麦布治疗老年稳定型心绞痛的临床疗效。方法:选择老年稳定型心绞痛60例,随机分为观察组和对照组各30例;对照组予以阿托伐他汀口服治疗,观察组予以阿托伐他汀联合依折麦布口服治疗,比较两组治疗前及治疗6个月后血脂水平、每周心绞痛发作次数、发作持续时间、硝酸甘油用量等指标变化。结果:(1)观察组治疗前血清总胆固醇(TC)为(6.35±2.30)mmol/L,与对照组的(6.10±2.25)mmol/L比较,差异不显著(P>0.05);观察组治疗后血清TC降为(3.21±1.29)mmol/L,与对照组的(4.05±1.38)mmol/L比较,差异显著(P<0.05)。观察组治疗前血清三酰甘油(TG)为(2.62±1.03)mmol/L,与对照组的(2.51±1.32)mmol/L比较,差异不显著(P>0.05);观察组治疗后血清TG降为(2.16±0.48)mmol/L,与对照组的(2.13±0.52)mmol/L比较,差异不显著(P>0.05)。观察组治疗前血清低密度脂蛋白胆固醇(LDL-C)为(4.63±1.75)mmol/L,与对照组的(4.52±1.65)mmol/L比较,差异不显著(P>0.05);观察组治疗后血清LDL-C降为(2.14±0.61)mmol/L,与对照组的(3.17±0.78)mmol/L比较,差异显著(P<0.05)。观察组治疗前血清高密度脂蛋白胆固醇(HDL-C)为(0.85±0.40)mmol/L,与对照组的(0.90±0.32)mmol/L比较,差异不显著(P>0.05);观察组治疗后血清HDL-C升为(1.39±0.33)mmol/L,与对照组的(1.32±0.25)mmol/L比较,差异不显著(P>0.05)。(2)观察组治疗前心绞痛发作次数为(4.34±1.20)次/周,与对照组的(4.27±1.25)次/周比较,差异不显著(P>0.05);观察组治疗后心绞痛发作次数降为(1.55±0.80)次/周,与对照组的(3.04±0.93)次/周比较,差异显著(P<0.05)。观察组治疗前硝酸甘油消耗量为(6.28±2.57)mg/周,与对照组的(6.35±2.72)mg/周比较,差异不显著(P>0.05);观察组治疗后硝酸甘油消耗量降为(1.92±0.66)mg/周,与对照组的(4.36±0.92)mg/周比较,差异显著(P<0.05)。(3)两组治疗期间各有1例因不稳定性心绞痛入院治疗,均未出现心肌梗死及心血管疾病死亡事件。(4)两组治疗期间均未出现严重不良反应,部分患者出现轻度胃肠道反应,无须特殊处理,均能顺利完成治疗;血(尿)常规、肝(肾)功能、心肌酶等监测结果均未出现明显异常。结论:阿托伐他汀联合依折麦布治疗老年稳定型心绞痛临床疗效较好。
引文
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[11]Jensen LO,Thayssen P,Pedersen KE,et al.Regression of coronaryatherosclerosis by simvastat in:A serial intravascular ultrasound study[J].Circulation,2001,104(4):387-392.
[12]胡大一.在循证医学原则指导下做好血脂异常的预防[J].中国实用内科杂志,2004,24(5):259-261.
[13]张新超,徐成斌,高岚,等.普伐他汀和辛伐他汀对人脐静脉内皮细胞黏附分子-1表达的影响[J].中华心血管病杂志,2001,29(2):111-114.
[14]田静文,方颖,周爱英.急性冠脉综合征初期他汀类药物短期治疗对内皮功能的影响[J].中国药业,2004,13(12):65-67.
[15]Miida T,Hirayama S,Nakamura Y.Cholesterol-independent effects of stlatins and new therapeutic targets:Ischemic stroke and dementia[J].J Atheroscler Thromb,2004,11(5):253-264.
[16]曲哲,刘佩,姚园,等.依折麦布联合瑞舒伐他汀钙治疗老年冠心病合并高脂血症的疗效观察[J].中西医结合心脑血管病杂志,2014,14(8):937-938.
[17]Davis HR Jr,Zhu LJ,Hoos LM,et al.Niemann-Pick C1 Like1(NPC1L1)is the intestinalphytosterol and cholesterol transporter and a key modulator of whole-body cholesterol homeostasis[J].J Biol Chem,2004,279(32):33586-33592.
[18]Smart EJ,De Rose RA,Farber SA.Annexin 2-caveolin lcomplex is a target of ezetimibe and regulates intestinal cholesteroltransport[J].Proc Natl Acad Sci USA,2004,101(10):3450-3455.
[19]冯毅,王积慧,沈成兴,等.急性冠状动脉综合征患者血浆蛋白氧化产物升高的机制及意义[J].中国动脉硬化杂志,2006,14(11):983-985.
[20]Sudhop T,Gottwald BM,von Bergmann K.Serum plant sterols as a potential risk factor for coronary heart disease[J].Metabolism,2002,51(12):1519-1521.
[21]Alexander KP,Blazing MA,Rosenson RS,et al.Management of hyperlipidemia in older adults[J].J Cardiovasc Pharmacol Ther,2009,14(1):49-58.
[22]Qi Y,Liu J,Ma C,et al.Association between cholesterol synthesis/absorption markers and effects of cholesterol lowering by atorvastatin among patients with high risk of coronary heart disease[J].J Lipid Res,2013,54(11):3189-3197.
[23]Padial LR.Ezetimibe plus simvastatin cardiovascular outcomes study program[J].Expert Rev Cardiovasc Ther,2008,6(1):17-25.
[24]陈巧莲.阿托伐他汀对ACS患者血浆炎症因子和颈动脉粥样硬化斑块的影响[J].中国药房,2011,22(28):2612-2614.
[25]Weingrtner O,Lütjohann D,Vanmierlo T,et al.Markers of enhanced cholesterol absorption are a strong predictor for cardiovascular diseases in patients without diabetes mellitus[J].Chem Phys Lipids,2011,164(6):451-456.
[26]Naruse R,Hori K,Terasawa T,et al.Alterations of plant sterols,lathosterol,oxidative stress and inflammatory markers after the combination therapy of ezetimibe and statin drugs in type 2diabetic patients[J].Obes Res Clin Pract,2015,9(1):67-74.
[27]Leiter LA,Betteridge DJ,Farnier M,et al.Lipid-altering efficacy and safety profile ofcombination therapy with ezetimibe/statin vs.statin monotherapy in patients with and without diabetes:An analysis of pooled data from 27clinical trials[J].Diabetes Obes Metab,2011,13(7):615-628.
[28]罗萍,王丽霞,朱好辉,等.阿托伐他汀联合依折麦布对冠状动脉粥样硬化性心脏病患者颈动脉粥样硬化斑块的影响[J].中华实验外科杂志,2014,31(2):289-291.
[29]Cholesterol Treatment Trialists’(CTT)Collaboration,Baigent C,Blackwell L,et al.Efficacy and safety of more intensive lowering of LDL cholesterol:A meta-analysis of data from 170 000participants in26randomised trials[J].Lancet,2010,376(9753):1670-1681.
[30]Cholesterol Treatment Trialists’(CTT)Collaborators,Mihaylova B,Emberson J,et al.The effects of loweringLDL cholesterol with statin therapy in people at low risk of vasculardisease:Meta-analysis of individual data from 27randomised trials[J].Lancet,2012,380(9841):581-590.
[31]Sabatine MS,Wiviott SD,Im K,et al.Efficacy and Safety of Further Lowering of Low-Density Lipoprotein Cholesterol in Patients Starting With Very Low Levels:A Meta-analysis[J].JAMA Cardiol,2018,3(9):823-828.
[32]王爽,郑秀艳,孙文,等.阿托伐他汀联合依折麦布对冠心病患者氧化应激及血脂水平的影响[J].现代生物医学进展,2017,17(13):2470-2473.
[33]方沐潮,曹乐,贝伟剑.依折麦布对饮食性高胆固醇血症大鼠胆固醇吸收及代谢相关靶点的调节作用[J].广东药学院学报,2015,31(2):219-223.
[2] Baigent C,Landray MJ,Reith C,et al.The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease(Study of Heart and Renal Protection):A randomized placebo-controlled trial[J].Lancet,2011,377(9784):2181-2192.
[3] Silverman MG, FerenceBA, ImK, etal.Association BetweenLowering LDL-C and Cardiovascular Risk Reduction Among DifferentTherapeutic Interventions:A Systematic Review and Meta-analysis[J].JAMA,2016,316(12):1289-1297.
[4]陈灏珠,林果为.实用内科学[M].15版.北京:人民卫生出版社,2017:965-966.
[5] Pekkanen J,Linn S,Heiss G,et al.Ten-year mortality from cardiovascular disease in relation to cholesterol level among men with and without preexisting cardiovascular disease[J].N Engl J Med,1990,322(24):1700-1707.
[6] Origasa h,Yokoyama M,Matsuzaki M,et al.Clinical importance of adherence to treatment with eicosapentaenoic acid by patients with hypercholesterolemia[J].Circ J,2010,74(37):510-517.
[7] Zhao S,Wang Y,Mu Y,et al.Prevalence of dyslipidaemia inpatients treated with lipid-lowering agents in China:Results of the DYSlipidemia International Study(DYSIS)[J].Atherosclerosis,2014,235(2):463-469.
[8] Jakulj L,Vissers MN,Groen AK,et al.Baseline cholesterolabsorption and the response to ezetimibe/simvastatin therapy:A posthocanalysis of the ENHANCE trial[J].J Lipid Res,2010,51(4):755-762.
[9]铁春苗,张娜.依折麦布治疗动脉粥样硬化性心血管疾病的研究进展[J].中华心血管病杂志,2015,43(7):646-649.
[10]王小军,王宗社,舒瑞超,等.冠脉搭桥术后肺水肿患者氧化应激状态的变化观察[J].现代生物医学进展,2016,16(23):4545-4547,4557.
[11]Jensen LO,Thayssen P,Pedersen KE,et al.Regression of coronaryatherosclerosis by simvastat in:A serial intravascular ultrasound study[J].Circulation,2001,104(4):387-392.
[12]胡大一.在循证医学原则指导下做好血脂异常的预防[J].中国实用内科杂志,2004,24(5):259-261.
[13]张新超,徐成斌,高岚,等.普伐他汀和辛伐他汀对人脐静脉内皮细胞黏附分子-1表达的影响[J].中华心血管病杂志,2001,29(2):111-114.
[14]田静文,方颖,周爱英.急性冠脉综合征初期他汀类药物短期治疗对内皮功能的影响[J].中国药业,2004,13(12):65-67.
[15]Miida T,Hirayama S,Nakamura Y.Cholesterol-independent effects of stlatins and new therapeutic targets:Ischemic stroke and dementia[J].J Atheroscler Thromb,2004,11(5):253-264.
[16]曲哲,刘佩,姚园,等.依折麦布联合瑞舒伐他汀钙治疗老年冠心病合并高脂血症的疗效观察[J].中西医结合心脑血管病杂志,2014,14(8):937-938.
[17]Davis HR Jr,Zhu LJ,Hoos LM,et al.Niemann-Pick C1 Like1(NPC1L1)is the intestinalphytosterol and cholesterol transporter and a key modulator of whole-body cholesterol homeostasis[J].J Biol Chem,2004,279(32):33586-33592.
[18]Smart EJ,De Rose RA,Farber SA.Annexin 2-caveolin lcomplex is a target of ezetimibe and regulates intestinal cholesteroltransport[J].Proc Natl Acad Sci USA,2004,101(10):3450-3455.
[19]冯毅,王积慧,沈成兴,等.急性冠状动脉综合征患者血浆蛋白氧化产物升高的机制及意义[J].中国动脉硬化杂志,2006,14(11):983-985.
[20]Sudhop T,Gottwald BM,von Bergmann K.Serum plant sterols as a potential risk factor for coronary heart disease[J].Metabolism,2002,51(12):1519-1521.
[21]Alexander KP,Blazing MA,Rosenson RS,et al.Management of hyperlipidemia in older adults[J].J Cardiovasc Pharmacol Ther,2009,14(1):49-58.
[22]Qi Y,Liu J,Ma C,et al.Association between cholesterol synthesis/absorption markers and effects of cholesterol lowering by atorvastatin among patients with high risk of coronary heart disease[J].J Lipid Res,2013,54(11):3189-3197.
[23]Padial LR.Ezetimibe plus simvastatin cardiovascular outcomes study program[J].Expert Rev Cardiovasc Ther,2008,6(1):17-25.
[24]陈巧莲.阿托伐他汀对ACS患者血浆炎症因子和颈动脉粥样硬化斑块的影响[J].中国药房,2011,22(28):2612-2614.
[25]Weingrtner O,Lütjohann D,Vanmierlo T,et al.Markers of enhanced cholesterol absorption are a strong predictor for cardiovascular diseases in patients without diabetes mellitus[J].Chem Phys Lipids,2011,164(6):451-456.
[26]Naruse R,Hori K,Terasawa T,et al.Alterations of plant sterols,lathosterol,oxidative stress and inflammatory markers after the combination therapy of ezetimibe and statin drugs in type 2diabetic patients[J].Obes Res Clin Pract,2015,9(1):67-74.
[27]Leiter LA,Betteridge DJ,Farnier M,et al.Lipid-altering efficacy and safety profile ofcombination therapy with ezetimibe/statin vs.statin monotherapy in patients with and without diabetes:An analysis of pooled data from 27clinical trials[J].Diabetes Obes Metab,2011,13(7):615-628.
[28]罗萍,王丽霞,朱好辉,等.阿托伐他汀联合依折麦布对冠状动脉粥样硬化性心脏病患者颈动脉粥样硬化斑块的影响[J].中华实验外科杂志,2014,31(2):289-291.
[29]Cholesterol Treatment Trialists’(CTT)Collaboration,Baigent C,Blackwell L,et al.Efficacy and safety of more intensive lowering of LDL cholesterol:A meta-analysis of data from 170 000participants in26randomised trials[J].Lancet,2010,376(9753):1670-1681.
[30]Cholesterol Treatment Trialists’(CTT)Collaborators,Mihaylova B,Emberson J,et al.The effects of loweringLDL cholesterol with statin therapy in people at low risk of vasculardisease:Meta-analysis of individual data from 27randomised trials[J].Lancet,2012,380(9841):581-590.
[31]Sabatine MS,Wiviott SD,Im K,et al.Efficacy and Safety of Further Lowering of Low-Density Lipoprotein Cholesterol in Patients Starting With Very Low Levels:A Meta-analysis[J].JAMA Cardiol,2018,3(9):823-828.
[32]王爽,郑秀艳,孙文,等.阿托伐他汀联合依折麦布对冠心病患者氧化应激及血脂水平的影响[J].现代生物医学进展,2017,17(13):2470-2473.
[33]方沐潮,曹乐,贝伟剑.依折麦布对饮食性高胆固醇血症大鼠胆固醇吸收及代谢相关靶点的调节作用[J].广东药学院学报,2015,31(2):219-223.