CAJ | 학술논문

目的：分析冠状动脉支架置入术后1年随访时低密度脂蛋白胆固醇（LDL-C）控制及他汀使用情况，并与新指南对照。方法入选2010年9月至2012年12月在解放军第三〇六医院心血管内科行冠状动脉支架置入术患者539例，随访1年，收集复查资料，包括LDL-C水平及生化指标以及他汀类药物使用情况。结果治疗1年后，按2004年ACC/AHA血脂指南LDL-C水平，达标373例（69.2%），未达标166例（30.8%）。按2013年ACC/AHA新指南评价，LDL-C水平达标195例（36.1%），未达标344例（63.9%）。两种标准评价是否一致Kappa值为-0.047，P=0.178，两种标准比较存在明显统计学差异。他汀类药物治疗以阿托伐他汀（n=247，10 mg~80 mg）和瑞舒伐他汀（n=147，5 mg~20 mg）为主，其他还包括辛伐他汀（n=139，25.7%，10 mg~40 mg），氟伐他汀（n=2，40 mg），普伐他汀（n=4，40 mg）。根据新指南中他汀类药物治疗强度，本研究中低强度降脂治疗21例（4.0%），中等强度512例（94.9%），高强度6例（1.1%），43例联合普罗布考治疗。结论按2013年新指南，冠状动脉支架置入术后他汀治疗1年，随访时多数患者LDL-C不达标，新指南是否适合中国人群需要进一步研究。
목적：분석관상동맥지가치입술후1년수방시저밀도지단백담고순（LDL-C）공제급타정사용정황，병여신지남대조。방법입선2010년9월지2012년12월재해방군제삼〇륙의원심혈관내과행관상동맥지가치입술환자539례，수방1년，수집복사자료，포괄LDL-C수평급생화지표이급타정류약물사용정황。결과치료1년후，안2004년ACC/AHA혈지지남LDL-C수평，체표373례（69.2%），미체표166례（30.8%）。안2013년ACC/AHA신지남평개，LDL-C수평체표195례（36.1%），미체표344례（63.9%）。량충표준평개시부일치Kappa치위-0.047，P=0.178，량충표준비교존재명현통계학차이。타정류약물치료이아탁벌타정（n=247，10 mg~80 mg）화서서벌타정（n=147，5 mg~20 mg）위주，기타환포괄신벌타정（n=139，25.7%，10 mg~40 mg），불벌타정（n=2，40 mg），보벌타정（n=4，40 mg）。근거신지남중타정류약물치료강도，본연구중저강도강지치료21례（4.0%），중등강도512례（94.9%），고강도6례（1.1%），43례연합보라포고치료。결론안2013년신지남，관상동맥지가치입술후타정치료1년，수방시다수환자LDL-C불체표，신지남시부괄합중국인군수요진일보연구。
Objective To analyze LDL-C control and statins administration during 1-year follow-up after coronary stent implantation, and compared with new Blood Fat Treatment Guideline of America (2013, new guideline). Methods The patients (n=539) underwent coronary stent implantation were chosen from Sept. 2010 to Dec. 2012, and followed up for 1 year for collecting reexamine data including LDL-C level, biochemical indexes and statins administration. Results After treatment for 1 year, there were 373 cases (69.2%) achieved target goal of LDL-C and 166 cases (30.8%) did not according to ACC/AHA guideline (2004). There were 195 cases (36.1%) achieved target goal of LDL-C and 344 cases (63.9%) did not according to new ACC/AHA guideline (2013). Kappa value was-0.047 (P=0.178). The statins were mainly atorvastatin (n=247, 10 mg-80 mg) and rosuvastatin (n=147, 5 mg-20 mg), and others included simuvastatin (n=139, 25.7%, 10 mg-40 mg), fluvastatin (n=2, 40 mg) and pravastatin (n=4, 40 mg). According to treatment intensity of statins in new guideline, there were 21 cases (4.0%) with low-intensity treatment, 512 cases (94.9%) with mid-intensity treatment and 6 cases (1.1%) with high-intensity treatment, and 43 cases were given statins combined probucol. Conclusion The level of LDL-C can not achieve target goal in most patients after coronary stent implantation and statins treatment for 1 year according the new guideline, so whether or not Chinese population is fit to the new guideline needs further study.