CAJ | 학술논문

目的探讨他汀联合苯扎贝特对急性冠状动脉综合征(ACS)患者的调脂疗效与安全性.方法选择住院确诊为ACS且合并血清甘油-三酯(TG)水平升高和(或)高密度脂蛋白胆固醇(HDL-C)降低的患者104例为研究对象,在常规治疗基础上按1∶1随机分为2组:(1)对照组(52例),给予阿托伐他汀20 mg每晚1次,或相当剂量的其他他汀治疗.(2)治疗组(52例),给予上述相同他汀联合苯扎贝特200 mg,2次/d治疗.分别于治疗前、治疗6周和12周后检测血清总胆固醇(TC)、TG、低密度脂蛋白胆固醇(LDL-C)和HDL-C水平,并记录不良反应及临床事件.结果治疗6周后,两组TC、TG、LDL-C水平均明显低于用药前,治疗12周后降低更为明显(P均＜0.05),且治疗组下降程度(分别为29.8％、38.0％、36.1％)大于对照组(分别为14.7％、9.8％、26.7％)(P均＜0.05);两组治疗后HDL-C均升高,尤以12周后升高更明显(P均＜0.05),对照组HDL-C升高幅度为19.3％,治疗组24.2％,但两组比较无统计学差异(P＞0.05).治疗12周后,治疗组LDL-C、TG、HDL-C、3项血脂指标均达标和非HDL-C的达标率(分别为69.2％、88.5％、92.3％、46.2％和65.4％)均明显高于对照组(分别为34.6％、65.4％、46.2％、7.7％和42.3％)(P均＜0.05).治疗期间两组均未观察到严重不良反应.结论伴TG升高和(或)HDL-C降低的ACS患者联合应用他汀和苯扎贝特治疗有助于血脂的全面达标,且安全性良好.
목적 탐토타정연합분찰패특대급성관상동맥종합정(ACS)환자적조지료효여안전성.방법 선택주원학진위ACS차합병혈청감유-삼지(TG)수평승고화(혹)고밀도지단백담고순(HDL-C)강저적환자104례위연구대상,재상규치료기출상안1∶1수궤분위2조:(1)대조조(52례),급여아탁벌타정20 mg매만1차,혹상당제량적기타타정치료.(2)치료조(52례),급여상술상동타정연합분찰패특200 mg,2차/d치료.분별우치료전、치료6주화12주후검측혈청총담고순(TC)、TG、저밀도지단백담고순(LDL-C)화HDL-C수평,병기록불량반응급림상사건.결과 치료6주후,량조TC、TG、LDL-C수평균명현저우용약전,치료12주후강저경위명현(P균＜0.05),차치료조하강정도(분별위29.8％、38.0％、36.1％)대우대조조(분별위14.7％、9.8％、26.7％)(P균＜0.05);량조치료후HDL-C균승고,우이12주후승고경명현(P균＜0.05),대조조HDL-C승고폭도위19.3％,치료조24.2％,단량조비교무통계학차이(P＞0.05).치료12주후,치료조LDL-C、TG、HDL-C、3항혈지지표균체표화비HDL-C적체표솔(분별위69.2％、88.5％、92.3％、46.2％화65.4％)균명현고우대조조(분별위34.6％、65.4％、46.2％、7.7％화42.3％)(P균＜0.05).치료기간량조균미관찰도엄중불량반응.결론 반TG승고화(혹)HDL-C강저적ACS환자연합응용타정화분찰패특치료유조우혈지적전면체표,차안전성량호.
Objective To investigate the lipid-regulating effect and safety of combined statin and bezafibrate therapy in acute coronary syndrome (ACS) patients complicating with dyslipedemia.Methods One hundred and four hospitalized patients with established ACS and increased serum triglycerides (TG) levels and/or low serum levels of high density lipoprotein cholesterol (HDL-C) were selected.Except for conventional therapy,the patients were randomly divided into 2 groups:control group (n =52),treated with atorvastatin 20 mg qn or other statin equivalent to 20 mg atorvastatin ; treatment group (n =52),treated with the same dose statin plus bezafibrate 200 mg bid.The serum levels of total cholesterol (TC),TG,lowdensity lipoprotein cholesterol (LDL-C) and HDL-C were assessed before and after 6 and 12 weeks treatment,side effects and adverse events were recorded.Results After 6 weeks treatment,the serum levels of TC,TG and LDL-C in two groups were significantly reduced compared to baseline (all P ＜ 0.05),which were further declined after 12 weeks treatment,and the reduction was more significant in treatment group(29.8％,38.0％ and 36.1％,respectively) than in control group (14.7％,9.8％ and 26.7％,respectively) (all P ＜ 0.05).After treatment,the serum levels of HDL-C in the two groups were significantly higher than the baseline levels,especially after 12 weeks treatment (all P ＜ 0.05),and the elevations of HDL-C levels in control group and in treatment group were 19.3％ and 24.2％,respectively,but there were no significant difference between the two groups (P ＞ 0.05).After 12 weeks,the rates reaching to target goals of LDL-C,TG,HDL-C,and non-HDL-C levels in the treatment group (69.2％,88.5％,92.3％,46.2％ and 65.4％,respectively) were significantly higher than those in the control group (34.6％,65.4％,46.2％,7.7％ and 42.3％,respectively,all P ＜ 0.05).No serious side effects were observed in the two groups during the treatment period.Conclusion The combined statin and bezafibrate treatment is safe and could increase the ratios of reaching target lipid levels in ACS patients complicating with increased TG and (or) decreased HDL-C.