CAJ | 학술논문

目的：观察不同剂量阿托伐他汀钙对冠心病合并微量白蛋白尿（MAU）患者血脂及尿微量白蛋白的影响。方法纳入2012年1月～2013年1月北京房山区第一医院冠心病患者80例，所有患者均合并高脂血症及微量白蛋白尿，将其随机等分为2组，在常规冠心病治疗的基础上A组予阿托伐他汀钙10 mg/d，B组予阿托伐他汀钙20 mg/d。治疗前及治疗12个月后观察两组患者的血脂水平[包括胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）和高密度脂蛋白胆固醇（HDL-C）]、MAU及随访中心脏缺血性事件的发生率；并观察两组在治疗期间不良反应发生情况（包括转氨酶升高、肌痛、磷酸肌酸激酶升高等）。结果治疗后，两组TC、TG和LDL-C均下降，HDL-C升高，但B组变化较A组更为明显[TC：（3.20±0.09）mmol/L vs.（4.21±0.37）mmol/L；TG：（1.73±0.21）mmol/L vs.（2.61±0.73）mmol/L；LDL-C：（1.98±0.19）mmol/L vs.（2.07±0.29）mmol/L；HDL-C：（1.32±0.47）mmol/L vs.（1.12±0.37）mmol/L]，差异有统计学意义（P＜0.05）；两组MAU亦较治疗前下降，但组间差异无统计学意义[（44.30±3.84）mg/L vs.（42.10±5.65）mg/L]；随访期间B组缺血事件发生率低于A组（6.4% vs.23.9%），差异有统计学意义（P＜0.01），两组均未出现肌痛或磷酸肌酸激酶升高等严重不良反应。结论阿托伐他汀能够有效改善冠心病合并MAU患者高脂血症和MAU水平，对预后改善有一定意义。
목적：관찰불동제량아탁벌타정개대관심병합병미량백단백뇨（MAU）환자혈지급뇨미량백단백적영향。방법납입2012년1월～2013년1월북경방산구제일의원관심병환자80례，소유환자균합병고지혈증급미량백단백뇨，장기수궤등분위2조，재상규관심병치료적기출상A조여아탁벌타정개10 mg/d，B조여아탁벌타정개20 mg/d。치료전급치료12개월후관찰량조환자적혈지수평[포괄담고순（TC）、감유삼지（TG）、저밀도지단백담고순（LDL-C）화고밀도지단백담고순（HDL-C）]、MAU급수방중심장결혈성사건적발생솔；병관찰량조재치료기간불량반응발생정황（포괄전안매승고、기통、린산기산격매승고등）。결과치료후，량조TC、TG화LDL-C균하강，HDL-C승고，단B조변화교A조경위명현[TC：（3.20±0.09）mmol/L vs.（4.21±0.37）mmol/L；TG：（1.73±0.21）mmol/L vs.（2.61±0.73）mmol/L；LDL-C：（1.98±0.19）mmol/L vs.（2.07±0.29）mmol/L；HDL-C：（1.32±0.47）mmol/L vs.（1.12±0.37）mmol/L]，차이유통계학의의（P＜0.05）；량조MAU역교치료전하강，단조간차이무통계학의의[（44.30±3.84）mg/L vs.（42.10±5.65）mg/L]；수방기간B조결혈사건발생솔저우A조（6.4% vs.23.9%），차이유통계학의의（P＜0.01），량조균미출현기통혹린산기산격매승고등엄중불량반응。결론아탁벌타정능구유효개선관심병합병MAU환자고지혈증화MAU수평，대예후개선유일정의의。
Objective To observe the influences of atorvastatin calcium on blood fat and microalbuminuria (MAU) in patients with coronary heart disease (CHD). Methods The patients (n=80) with CHD complicating hyperlipidemia and MAU were chosen from the First Hospital of Beijing Fangshan District from Jan. 2012 to Jan. 2013. All patients were divided into 2 groups, and group A was treated with routine therapy of CHD and atorvastatin calcium (10 mg/d) and group B, routine therapy of CHD and atorvastatin calcium (20 mg/d). Before treatment and 12 months after treatment, the levels of blood fat [total cholesterol (TC), triglyceride (TG), low-density lipoprotein-cholesterol (LDL-C) and high-density lipoprotein-cholesterol (HDL-C)], MAU, incidence of major adverse cardiovascular events (MACE) during follow-up period, and incidence of adverse reactions (transaminase increasing, muscle pain and creatine phosphate kinase increasing) were observed in two groups. Results After treatment, the levels of TC, TG and LDL-C decreased and HDL-C level increased in two groups, which were more significant in group B [TC:(3.20±0.09) mmol/L vs. (4.21±0.37) mmol/L, TG:(1.73±0.21) mmol/L vs. (2.61± 0.73) mmol/L, LDL-C:(1.98±0.19) mmol/L vs. (2.07±0.29) mmol/L, HDL-C:(1.32±0.47) mmol/L vs. (1.12± 0.37) mmol/L]. MAU decreased also after treatment in two groups but the difference had no statistical significance between two groups [(44.30±3.84) mg/L vs. (42.10±5.65) mg/L]. During follow-up period, the incidence of MACE was lower in group B than that in group A (6.4%vs. 23.9%, P<0.01). There were no adverse reactions (muscle pain and creatine phosphate kinase increasing) observed. Conclusion Atorvastatin calcium can alleviate hyperlipidemia and MAU and improve prognosis in CHD patients. The higher the dose, the better the curative effect.