瑞舒伐他汀联合依折麦布调脂治疗对冠状动脉粥样硬化性心脏病患者胆固醇代谢标志物的影响

摘要

目的 探讨瑞舒伐他汀联合依折麦布调脂治疗对冠状动脉粥样硬化性心脏病(冠心病)患者胆固醇代谢标志物的影响.方法 连续入选2014年1月至2015年6月于首都医科大学附属北京安贞医院特需医疗科住院的冠心病患者104例,每日均接受瑞舒伐他汀10 mg治疗,根据4周后血脂水平分为血脂达标组(75例)和血脂未达标组(29例).血脂达标组继续同前服用瑞舒伐他汀至12周,血脂未达标组加用依折麦布10 mg/次,1次/d治疗至12周.所有入选患者均于治疗前及治疗4、12周后测定血脂及胆固醇合成标志物和吸收标志物含量.结果 ①104例冠心病患者治疗4周后,总胆固醇、LDL-C水平及7-烯胆甾烷醇含量较治疗前明显下降,谷固醇/总胆固醇比值较治疗前明显升高,差异均有统计学意义[(3.20±0.14) mmol/L比(4.41±1.23) mmol/L、(2.03 ±0.12) mmol/L比(2.92±0.20) mmol/L、(13.3±2.0) mg/L比(16.1±2.9) mg/L、(10.4 ±0.8)mg/g比(8.8±0.6)mg/g](均P＜0.05).②血脂达标组继续他汀治疗12周后,总胆固醇、LDL-C水平较治疗4周后呈增高趋势,但差异无统计学意义(P＞0.05),胆固醇代谢标志物亦无明显改变,差异无统计学意义(P＞0.05).③血脂未达标组治疗12周后与治疗4周后比较,总胆固醇、LDL-C、菜油固醇、谷固醇含量以及菜油固醇/总胆固醇比值明显下降,差异均有统计学意义[(2.65±0.23) mmol/L比(3.28 ±0.17)mmol/L、(2.03 ±0.09) mmol/L比(2.40±0.11) mmol/L、(4.2±0.5) mg/L比(7.0±0.9) mg/L、(12.1 ±1.1)mg/L比(14.3±1.2)mg/L、(3.2±0.4) mg/g比(5.2 ±0.4) mg/g](均P＜0.05).结论 在他汀类药物治疗的基础上联合依折麦布治疗可以减少胆固醇的吸收,并进一步降低血中胆固醇水平,提高血脂达标率.%Objective To explore the effect of antilipemic therapy of rosuvastatin combined with ezetimibe on cholesterol metabolism markers in patients with coronary atherosclerotic heart disease(CHD).Methods Totally 104 patients with CHD from January 2014 to June 2015 in Beijing Anzhen Hospital,Capital Medical University were enrolled.After 4 weeks of treatment with atorvastatin,all patients were divided into blood lipid attainment group (75cases) and blood lipid non-attainment group (29 cases).Blood lipid attainment group was treated with rosuvastatin for next 8 weeks,blood lipid non-attainment group was treated with rosuvastatin and ezetimibe for next 8 weeks.Concentrations of blood lipid,cholesterol synthesis markers and cholesterol absorption markers were measured before treatment and after 4,12 weeks of treatment.Results ①In all of 104 CHD patients,total cholesterol(TC) level,low-density lipoprotein cholesterol (LDL-C) level and the absolute value of lathosterol after 4 weeks of treatment were significantly lower than those before treatment,the specific value of sitosterol/TC after 4 weeks of treatment was significantly lower than that before treatment [(3.20 ± 0.14) mmol/L vs (4.41 ± 1.23) mmol/L,(2.03 ±0.12)mmol/Lvs (2.92 ± 0.20) mmol/L,(13.3±2.0)mg/L vs (16.1 ±2.9)mg/L,(10.4±0.8)mg/g vs (8.8 ±0.6) mg/g] (P ＜ 0.05).②In blood lipid attainment group,differences of TC,LDL-C and cholesterol metabolism markers were not significant between values after 12 weeks of treatment and those after 4 weeks of treatment(P ＞0.05).③In blood lipid non-attainment group,TC,LDL-C,campesterol,sitosterol and campesterol/TCafter 12 weeks of treatment were significantly lower than those after 4 weeks of treatment[(2.65 ± 0.23) mmol/L vs(3.28 ±0.17) mmol/L,(2.03 ± 0.09) mmol/L vs (2.40 ± 0.11) mmol/L,(4.2 ± 0.5) mg/L vs (7.0 ±0.9)mg/L,(12.1 ±1.1)mg/L vs (14.3 ± 1.2)mg/L,(3.2 ±0.4)mg/g vs (5.2 ±0.4) mg/g] (all P ＜0.05).Conclusion Antilipemic therapy combination of rosuvastatin and ezetimibe can reduce cholesterol absorption and further lower the level of thod lipid.