Objective To investigate the effects of atorvastatin combined with ezetimibe on serum cholesterol synthesis and absorption in acute coronary syndrome patients not achieving LDL-C goal.Methods Eighty ACS patients not achieving LDL-C goal in our hospital from June 2012 to June 2014 were randomly divided into atorvastatin plus ezetimibe group (n=42,atorvastatin 20 mg/d plus ezetimibe 10 mg/d) and atorvastatin double-dose group (n=38,atorvastatin 40 mg/d).Serum cholesterol synthesis and absorption markers were measured before and after 12-week treatment.Results After 12 weeks,the serum LDL-C level was significantly lower in atorvastatin plus ezetimibe group than that in double dose atorvastatin group [(1.81 ± 0.38) mmol/L vs (2.01 ± 0.43) mmol/L,P ＜ 0.05].Serum cholesterol synthesis markers (lathosterol,24-dehydrogenation) decreased after 12-week treatment in the two groups,particularly in double dose atorvastatin group.Cholesterol absorption markers (campesterol,stigmasterol,sitosterol) decreased in atorvastatin plus ezetimibe group after 12-week treatment (P ＜ 0.05,respectively).However,they increased in the double dose atorvastatin group.Conclusion Atorvastatin combined with ezetimibe reduce cholesterol synthesis and absorption markers at the same time in acute coronary syndrome patients not achieving LDL-C goal.%目的 探讨依折麦布联合阿托伐他汀类对低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)未达标的急性冠脉综合征(acute coronary syndrome,ACS)患者血清胆固醇代谢标记物7烯胆甾醇、24-脱氢胆甾烷醇、油菜甾醇、豆固醇和谷甾醇的影响.方法 入选2012年6月-2014年6月于我院住院的ACS患者,常规应用他汀类药物4周后LDL-C未达标80例,随机分为双倍阿托伐他汀钙治疗组(40 mg,每晚1次)38例和阿托伐他汀钙联合依折麦布治疗组(阿托伐他汀钙20 mg,每晚1次;加用依折麦布10 mg,每晚1次)42例,治疗12周后,分析两组治疗前后血清胆固醇代谢标记物的变化.结果 治疗12周后阿托伐他汀钙联合依折麦布治疗组LDL-C水平较双倍阿托伐他汀钙治疗组明显下降[(1.81±0.38) mmol/L vs(2.01±0.43) mmol/L,P＜0.05],两治疗组7烯胆甾醇和24-脱氢胆甾烷醇水平较治疗前均下降,双倍阿托伐他汀钙治疗组下降更明显(P均＜0.05).治疗后12周后,阿托伐他汀钙联合依折麦布治疗组油菜甾醇、豆固醇和谷甾醇水平均明显下降,而双倍阿托伐他汀钙治疗组油菜甾醇、豆固醇和谷甾醇水平均明显上升.结论 对于应用他汀类药物后LDL-C不达标的ACS患者,阿托伐他汀钙联合依折麦布可同时降低胆固醇代谢标记物7烯胆甾醇、24-脱氢胆甾烷醇、油菜甾醇、豆固醇和谷甾醇,更有效地降低LDL-C水平.
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