阿托伐他汀对合并微量白蛋白尿冠心病患者心肾联合保护作用的探讨

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(P0.05);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(P0.01),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。

Synthetic protective effect of atorvastatin calcium on heart and kidney in patients with coronary heart disease complicating microalbuminuria

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.