CAJ | 학술논문

目的观察老年患者应用阿托伐他汀、瑞舒伐他汀及血脂康的疗效与安全性.方法回顾性分析2009年1月至2014年3月于北京大学第一医院就诊或住院的服用他汀类的老年患者314例,年龄60～94(73.6±7.9)岁.根据服用他汀种类分为3组:阿托伐他汀组108例,平均剂量(16.4 ±4.8)mg/d;瑞舒伐他汀组104例,平均剂量(8.7±3.0) mg/d;血脂康组102例,平均剂量(0.9 ±0.3)g/d.观察治疗前及治疗4周后的血脂水平、丙氨酸氨基转移酶(ALT)及肌酸激酶(CK)情况.依据2007年《中国成人血脂异常防治指南》推荐的心血管疾病危险分层方案,各组患者分为中危(3组分别为13、12和21例)、高危(3组分别为40、44和48例)和极高危(3组分别为55、48和33例),计算各组不同危险分层血脂达标率及达标剂量.结果 3组患者治疗4周后血清总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、非高密度脂蛋白胆固醇(非HDL-C)水平与治疗前比较均明显下降(P均＜0.01).治疗前后LDL-C水平,阿托伐他汀组分别为(3.14±0.78)和(2.14±0.65) mmol/L,瑞舒伐他汀组分别为(2.92±0.77)和(1.96±0.55)mmol/L,血脂康组分别为(2.70±0.62)和(2.16 ±0.61)mmol/L,P均＜0.01.治疗后LDL-C达标率,阿托伐他汀组、瑞舒伐他汀组及血脂康组的中危患者分别为13/13、11/12和20/21,高危患者分别为95.0％ (38/40)、86.4％(38/44)和83.3％ (40/48),极高危患者分别为40.0％ (22/55)、62.5％ (30/48)和51.5％ (17/33).不同危险分层的3组患者LDL-C、非HDL-C及TC达标率差异均无统计学意义(P＞0.05).阿托伐他汀组1例患者ALT出现3倍以上升高,各组均无CK升高超过正常上限5倍者.结论老年心血管病患者应用小剂量和(或)常规剂量的阿托伐他汀、瑞舒伐他汀及血脂康降脂治疗安全、有效.
목적 관찰노년환자응용아탁벌타정、서서벌타정급혈지강적료효여안전성.방법 회고성분석2009년1월지2014년3월우북경대학제일의원취진혹주원적복용타정류적노년환자314례,년령60～94(73.6±7.9)세.근거복용타정충류분위3조:아탁벌타정조108례,평균제량(16.4 ±4.8)mg/d;서서벌타정조104례,평균제량(8.7±3.0) mg/d;혈지강조102례,평균제량(0.9 ±0.3)g/d.관찰치료전급치료4주후적혈지수평、병안산안기전이매(ALT)급기산격매(CK)정황.의거2007년《중국성인혈지이상방치지남》추천적심혈관질병위험분층방안,각조환자분위중위(3조분별위13、12화21례)、고위(3조분별위40、44화48례)화겁고위(3조분별위55、48화33례),계산각조불동위험분층혈지체표솔급체표제량.결과 3조환자치료4주후혈청총담고순(TC)、저밀도지단백담고순(LDL-C)、비고밀도지단백담고순(비HDL-C)수평여치료전비교균명현하강(P균＜0.01).치료전후LDL-C수평,아탁벌타정조분별위(3.14±0.78)화(2.14±0.65) mmol/L,서서벌타정조분별위(2.92±0.77)화(1.96±0.55)mmol/L,혈지강조분별위(2.70±0.62)화(2.16 ±0.61)mmol/L,P균＜0.01.치료후LDL-C체표솔,아탁벌타정조、서서벌타정조급혈지강조적중위환자분별위13/13、11/12화20/21,고위환자분별위95.0％ (38/40)、86.4％(38/44)화83.3％ (40/48),겁고위환자분별위40.0％ (22/55)、62.5％ (30/48)화51.5％ (17/33).불동위험분층적3조환자LDL-C、비HDL-C급TC체표솔차이균무통계학의의(P＞0.05).아탁벌타정조1례환자ALT출현3배이상승고,각조균무CK승고초과정상상한5배자.결론 노년심혈관병환자응용소제량화(혹)상규제량적아탁벌타정、서서벌타정급혈지강강지치료안전、유효.
Objective To compare the efficacy and safety of atorvastatin,rosuvastatin and xuezhikang capsule in elderly.Methods A total of 314 60-to-94-year-old (average (73.6 ± 7.9) years old) patients who were given different doses and types of statins were divided into three groups:the atorvastatin group (108 patients),the rosuvastatin group (104 patients) and the xuezhikang capsule group (102 patients).The serum TG,TC,LDL-C,HDL-C,ALT and CK were examined before and after the treatment which lasted for at least 4 weeks.All patients were divided into moderate risk group (13,12 and 21 patients respectively in 3 groups) ; high risk group (40,44 and 48 patients respectively in 3 groups) and very high risk group (55,48 and 33 patients respectively in 3 groups) according to guidelines on prevention and treatment of dyslipidemia in chinese adults (2007 version).The rate of reaching target goal and the dose when reaching target levels in different risk stratification groups were calculated and compared.Results Serum TC,LDL-C and non-HDL-C were significantly reduced after the 4-week-treatment in all the three groups (P ＜ 0.01).Serum LDL-C level before and after treatment were (3.14 ± 0.78) mmol/L vs.(2.14 ±0.65) mmol/L in atorvastatin group (the arevage dose was (16.4 ± 4.8) mg/d),(2.92 ± 0.77)mmol/L vs.(1.96 ±0.55) mmol/L in rosuvastatin group (the arevage dose was (8.7 ±3.0) mg/d),and (2.70 ±0.62) mmol/L vs.(2.16 ±0.61) mmol/L in xuezhikang capsule group (the arevage dose was (0.9 ± 0.3) g/d).Among all the three groups of patients,the cases of reaching target levels of LDL-C were 13,11 and 20 in patients at moderate risk,were 38(95.0％),38(86.4％) and 40 (83.3％) in patients at high risk,and were 22(40.0％),30(62.5％) and 17(51.5％) in patients at very high risk.There were no statistical differences in the rate of reaching target levels of LDL-C,non-HDL-C and TC in the three groups and at different risks (P ＞ 0.05).One patient in the atorvastatin group showed ALT level elevation ＞ 3 times of the upper limit of normal value,there was no patient with CK level elevation ＞ 5 times of the upper limit of normal value.Conclusion Atorvastatin,rosuvastatin and xuezhikang capsule at low dose and/or standard dose are effective and safety in elderly patients.