摘要
目的探讨三种不同剂量(10 mg,20 mg,40 mg)辛伐他汀对老年冠心病患者血脂和血管内皮功能的影响。方法入选确诊的老年冠心病患者106例(男68例,女38例),随机分为3组:A组53例(男34例,女19例),B组51例(男33例,女18例),C组52例(男33例,女19例),D组(健康对照组)40例(男26例,女14例)。A组、B组、C组分别给予辛伐他汀10 mg2、0 mg、40 mg,每日1次口服。采用超声法检测血流介导的肱动脉内皮依赖性舒张功能(FMD),同时观察血脂水平的变化。结果A、B、C各组治疗后总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平均较治疗前显著降低(P<0.05),各组治疗后4周、8周、12周和24周TC、LDL-C水平之间差异亦有显著性(P<0.05),呈现C组>B组>A组趋势。各组辛伐他汀治疗4周后TC、LDL-C已有明显下降,随着治疗时间的延长,TC、LDL-C进一步降低,12周达高峰,至24周仍维持有效水平。辛伐他汀降低TC、LDL-C呈明显量效关系。辛伐他汀治疗可明显改善老年冠心病患者的血管内皮功能。A、B、C各组治疗前FMD较正常对照组(D组)明显降低(P<0.05),随着治疗时间的延续,各组FMD较治疗前明显增加(P<0.05),A组4、8、12、24周FMD分别增加24%、47%、74%、100%;B组分别增加48%、61%、97%、90%;C组分别增加47%、68%、116%、141%,说明动脉内皮功能明显改善。但FMD变化值在不同剂量辛伐他汀组(A、B、C组)之间差异无显著性(P>0.05),说明辛伐他汀改善血管内皮功能与其剂量无关。所有患者耐受性好,但不良反应随剂量增加而增加。结论辛伐他汀治疗老年冠心病患者4周时,TC、LDL-C明显下降,同时血管内皮功能改善。长期治疗能达到调脂及持续改善血管内皮功能的效果。辛伐他汀20 mg/d治疗老年高脂血症无论从调脂效果、安全性等方面为最佳选择。不同剂量辛伐他汀均可显著改善老年冠心病患者FMD,其改善程度无显著不同,可能独立于调脂作用之外。
Objective To investigate the effects of three doses（ 10 mg,20 mg,40 mg） of simvastatin on blood fat and blood vessel endothelium function of elderly coronary artery disease patients.Methods 106 elderly coronary artery diaease patients were enrolled in this study（male 68,female 38）and divided into 3 groups randomly： group A, n = 53（male 34, female 19） ,group B, n = 51 （male 33, female 18）, group C, n = 52（male 33, female 19）, group D（ control group）, n = 40（ male 26, female 14）. The patients of group A, B, and C were administrated 10 mg, 20 mg, 40 mg simvastatin by mouth one time per day, respectively. Brachial artery endothelium-dependent diastolic function mediated by blood flow was determined through super sound method and change of blood fat level was observed at the same time. Results After administrated, the levels of TC and LDL-C in group A, B, C were significantly lower than flint before administrated（ P 〈 0.05）. Among group A, B, C, the levels of TC and LDL-C at 4,8,12,24 weeks after administrated were significantly dlfferent（P〈 0.05）.Group c〉 Group B〉 Group A.The levels Of TC and LDL-C of group A,B,C at 4 weeks after admitfistrated decreased obviously. Following the administration time, the levels of TC and LDL-C continued to decrease and at 12 weeks,they reached peak and maintained effective level at 24 weeks. Simvastatin decreased the levels of TC and LDL-C dose-dependently. Simvastatin may significantly improve blood vessel endothelium function of elderly coronary artery disease. Before administrated, FMD of group A, B, C were significantly lower than that of control group（ group D） （ P 〈 0.05）. After administrated, FMD of these groups were significantly higher than that before administrated（ P 〈 0.05）. In group A, FMD at 4,8,12,24 weeks after administrated increased by24%, 47 %, 74 %, 100%, respectively. In group B, FMD at 4,8,12,24 weeks after administrated increased by 48% ,61% ,97% ,90% ,respectively.In group C,FMD at 4,8,12,24 weeks af
出处
《中国实验诊断学》
2008年第6期761-766,共6页
Chinese Journal of Laboratory Diagnosis
关键词
辛伐他汀
老年冠心病
血脂异常
血管内皮功能
simvastatin
elderly coronary artery disease
blood fat abnormality
blood vessel endothelium function
