CAJ | 학술논문

目的：观察瑞舒伐他汀对冠心病合并糖尿病患者非高血脂状态下进行强化治疗后的临床心血管事件，提出早期强化降脂的必要性。方法选择冠心病合并糖尿病患者324例，入院检测低密度脂蛋白胆固醇-C（LDL-C＜3．36 mmol/L），将其随机分为他汀组176例（瑞舒伐他汀10 mg/d）和对照组148例，所有患者均经过强化降糖、抗血小板、抗心肌缺血、戒烟、调整饮食、加强运动等冠心病二级预防治疗，必要时行冠状动脉造影及冠状动脉内支架植入术或是冠状动脉旁路移植术等。随访（13±6）个月，观察指标：空腹血糖、LDL-C、高敏C反应蛋白及临床心血管事件（心脏性猝死、再发心绞痛及靶血管重建等）。结果他汀组患者空腹血糖、LDL-C及hs-CRP均显著比对照组降低[血糖：（5．3±0．9） mmol/L 与（6．7±1．2） mmol/L，P＝0.042；LDL-C：（1．7±0.6）mmol/L与（3．9±1．6）mmol/L，t＝-2．36，P＜0．01；hs-CRP：（1．4±0．5）mmol/L与（3．8±1．2）mg/L，t＝-2．48，P＜0.01，临床心血管事件（15．6％与37．1％），χ2＝4．78，P＝0．032。结论应该早期强化对冠心病合并糖尿病患者进行降脂治疗，即使血脂不高，可以显著降低临床心血管事件。
목적：관찰서서벌타정대관심병합병당뇨병환자비고혈지상태하진행강화치료후적림상심혈관사건，제출조기강화강지적필요성。방법선택관심병합병당뇨병환자324례，입원검측저밀도지단백담고순-C（LDL-C＜3．36 mmol/L），장기수궤분위타정조176례（서서벌타정10 mg/d）화대조조148례，소유환자균경과강화강당、항혈소판、항심기결혈、계연、조정음식、가강운동등관심병이급예방치료，필요시행관상동맥조영급관상동맥내지가식입술혹시관상동맥방로이식술등。수방（13±6）개월，관찰지표：공복혈당、LDL-C、고민C반응단백급림상심혈관사건（심장성졸사、재발심교통급파혈관중건등）。결과타정조환자공복혈당、LDL-C급hs-CRP균현저비대조조강저[혈당：（5．3±0．9） mmol/L 여（6．7±1．2） mmol/L，P＝0.042；LDL-C：（1．7±0.6）mmol/L여（3．9±1．6）mmol/L，t＝-2．36，P＜0．01；hs-CRP：（1．4±0．5）mmol/L여（3．8±1．2）mg/L，t＝-2．48，P＜0.01，림상심혈관사건（15．6％여37．1％），χ2＝4．78，P＝0．032。결론응해조기강화대관심병합병당뇨병환자진행강지치료，즉사혈지불고，가이현저강저림상심혈관사건。
Objective To compare main adverse cardiac events of patients with coronary heart disease and diametes,but normal lipids after statin on lowering lipids , and to bring out necessity of early lowering lipids . Methods A total of 324 patients with coronary heart disease and diametes were enrolled ,LDL-C was measured in-hospital for all patients and LDL-C<3.36mmol/L suitable for the experiment .They were divided into statin group (n=176,rosuvastatin 10 mg/d)and control group(n=148)randomly,all patients received second prevention for cor-onary heart disease including anti-platelet,anti-myocardial ischemia,smoke quitting,adjust diets and exercise,the CAG or PTCA(and stent implanting),CABG.the end events were main adverse cardiac events (cardiac events,recur-rent angina and target vessel reconstruction ).The mean follow-up time was(13 ±6)months.Results The fasting plasma glucose,LDL-C,hs-CRP in statin group were all significantly lower than those of control group [FPG:(5.3 ± 0.9)vs.(6.7 ±1.2)mmol/L,P=0.042;LDL-C:(1.7 ±0.6)mmol/Lvs.(3.9 ±1.6)mmol/L,P<0.01;hs-CRP:(1.4 ±0.5)mmol/L vs.(3.8 ±1.2)mg/L,P <0.01],MACE were less(15.6% vs.37.1%,P =0.032). Conclusion Early statin on patient with coronary heart disease and diametes ,though normal lipids ,which can down-regulate main adverse cardiac events significantly .