• 上海交通大學(xué)附屬上海胸科醫(yī)院（上海 200030）;

目的 　探討國(guó)人經(jīng)皮冠狀動(dòng)脈介入治療（PCI）術(shù)后20 mg/d阿托伐他汀（立普妥）強(qiáng)化降脂的效果，以及對(duì)心臟事件的影響。
方法 　采用雙盲1∶1分層隨機(jī)對(duì)照的試驗(yàn)設(shè)計(jì)，納入2005年7月～2006年6月上海胸科醫(yī)院120例冠心病介入治療病人，隨機(jī)分為強(qiáng)化調(diào)脂組（A組，60例，阿托伐他汀20 mg/d）和普通調(diào)脂組（B組，60例，阿托伐他汀10 mg/d）。用藥時(shí)間自PCI術(shù)后當(dāng)日至術(shù)后3月，而后兩組均采用阿托伐他汀10 mg/d至術(shù)后1年。于術(shù)前、術(shù)后1月、3月、6月進(jìn)行血液生化檢查，隨訪心臟事件，觀察藥物不良反應(yīng)。
結(jié)果 　該120例病人中，剔除5例，脫落4例，115例病人進(jìn)入意向治療（ITT）分析，符合方案（PP）分析111例，兩組基線特征具有可比性（P gt;0.05）；兩組血脂水平比較，TG下降幅度和HDL-C升高幅度差異無(wú)統(tǒng)計(jì)學(xué)意義（P gt;0.05），而LDL-C和TC下降幅度差異有統(tǒng)計(jì)學(xué)意義（P lt;0.05），這種差異從隨訪到術(shù)后3個(gè)月時(shí)開(kāi)始出現(xiàn)；PP分析中，術(shù)后3個(gè)月時(shí)兩組LDL-C的達(dá)標(biāo)率分別為87.03%和70.17%，其差異有統(tǒng)計(jì)學(xué)意義（P=0.031），ITT分析與PP分析結(jié)果一致（P=0.044）；兩組比較，術(shù)后1個(gè)月及3個(gè)月時(shí)CRP變化差異有統(tǒng)計(jì)學(xué)意義（P lt;0.05），術(shù)后6個(gè)月時(shí)CRP變化趨于穩(wěn)定（P gt;0.05）；A組隨訪6.5±3.0個(gè)月，復(fù)發(fā)心絞痛1例，血運(yùn)重建1例；B組隨訪7.2±3.6個(gè)月，復(fù)發(fā)心絞痛3例，致死性/非致死性心梗1例，血運(yùn)重建2例，心源性猝死1例，Kaplan-Meier事件曲線從術(shù)后4個(gè)月時(shí)開(kāi)始分離，并且差異有統(tǒng)計(jì)學(xué)意義（P=0.048）；兩組藥物不良反應(yīng)輕微，均未有橫紋肌溶解現(xiàn)象發(fā)生。
結(jié)論 　PCI術(shù)后應(yīng)用阿托伐他汀20 mg/d強(qiáng)化降脂安全有效。

引用本文： 王承,潘欣,陳暉,袁方,徐蕾,方唯一. 阿托伐他汀強(qiáng)化降脂治療對(duì)PCI術(shù)后心臟事件的影響. 中國(guó)循證醫(yī)學(xué)雜志, 2007, 07(4): 244-250. doi: 復(fù)制

版權(quán)信息： ?四川大學(xué)華西醫(yī)院華西期刊社《中國(guó)循證醫(yī)學(xué)雜志》版權(quán)所有，未經(jīng)授權(quán)不得轉(zhuǎn)載、改編

1. The blood lipids disorders prevention and cure special topic group of Chinese journal cardiology editorial committee. Prevention and cure recommendation to blood lipids disorders. Chin J Cardiol, 1997, 25(3): 169-175.
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10. Pedersen TR, Faergeman O, Kastelein JJP, et al. High-Dose Atorvastatin vs Usual-Dose Simvastatin for Secondary Prevention After Myocardial Infarction. JAMA, 2005, 294(19): 2437-2445.
11. Nissen SE, Tuzcu EM, Schoenhagen P, et al. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary at artherosclerosis: a randomized controlled trial. JAMA, 2004, 291(9): 1071-1080.
12. Jones PH, McKenney JM, Karalis DG, et al. Comparison of the efficacy and safety of atorvastatin initiated at different starting doses in patients with dyslipidenia. Am Heart J, 2005, 149(1): e1.
13. 全國(guó)高膽固醇血癥控制狀況多中心研究協(xié)作組. 高膽固醇血癥臨床控制狀況多中心協(xié)作研究——達(dá)標(biāo)率及影響因素. 中華心血管病雜志, 2002, 30(2): 109~114.
14. Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ, 2003, 326(7404): 1423.
15. Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation, 2003, 107(3): 363-369.
16. Almagor M, Keren A, Banai S. Increased C-reactive protein level after coronary stent implantation in patients with stable coronary artery disease. Am Heart J, 2003, 145(2): 248-253.
17. 血脂治療現(xiàn)狀調(diào)查協(xié)作組. 我國(guó)血脂異常治療現(xiàn)狀的調(diào)查. 中華心血管病雜志, 2001, 29(1): 15~17.
18. Law M, Rudnicka AR. Statin safety: a systematic review. Am J Cardiol, 2006, 97(8A): 52C-60C.
19. Ucar M, Mjorndal T, Dahlqvist R. HMG-CoA reductase inhibitors and myotoxicity. Drug Saf, 2000, 22(6): 441-457.
  1. 1. The blood lipids disorders prevention and cure special topic group of Chinese journal cardiology editorial committee. Prevention and cure recommendation to blood lipids disorders. Chin J Cardiol, 1997, 25(3): 169-175.
  2. 2. The Current Status in Clinical Control of Hypercholesterolemia in China Collaborative Research Group. A multi-center study of current status on clinical control of hypercholesterolemia in China. Chin J Cardiol, 2002, 30(2): 109-114.
  3. 3. Status of Treatment of Blood Lipids Study Group. A survey of treatment status of blood lipids disorders in China. Chin J Cardiol, 2001, 29(1): 15-17.
  4. 4. Grundy SM, Cleeman J I, Stone NJ, et al. The Coordinating Committee of the National Cholesterol Education Program. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel Ⅲ Guidelines. Circulation, 2004, 44(33): 720-732.
  5. 5. Takemoto M, Liao JK. Pleiotropic effects of 3-hydroxy-3-met hylglutaryl coenzyme a reductase inhibitors. Arterioscler Thromb Vasc Biol, 2001, 21(11): 1712-1719.
  6. 6. 中華心血管病雜志編輯委員會(huì)血脂異常防治對(duì)策專題組. 血脂異常防治建議. 中華心血管病雜志, 1997, 25(3): 169~175.
  7. 7. ACC/AHA Task Force. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures. J Am Coll Cardiol, 1988, 12(2): 529-545.
  8. 8. Cannon CP, Braunwald E, Mccabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med, 2004, 350(15): 1495-1504.
  9. 9. Larosa JC, Grundy SM, Waters DD, et al. Intensive lipid lowering with atorvastatin in ptients with stable coronary disease. N Engl J Med, 2005, 352(14): 1425-1435.
  10. 10. Pedersen TR, Faergeman O, Kastelein JJP, et al. High-Dose Atorvastatin vs Usual-Dose Simvastatin for Secondary Prevention After Myocardial Infarction. JAMA, 2005, 294(19): 2437-2445.
  11. 11. Nissen SE, Tuzcu EM, Schoenhagen P, et al. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary at artherosclerosis: a randomized controlled trial. JAMA, 2004, 291(9): 1071-1080.
  12. 12. Jones PH, McKenney JM, Karalis DG, et al. Comparison of the efficacy and safety of atorvastatin initiated at different starting doses in patients with dyslipidenia. Am Heart J, 2005, 149(1): e1.
  13. 13. 全國(guó)高膽固醇血癥控制狀況多中心研究協(xié)作組. 高膽固醇血癥臨床控制狀況多中心協(xié)作研究——達(dá)標(biāo)率及影響因素. 中華心血管病雜志, 2002, 30(2): 109~114.
  14. 14. Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ, 2003, 326(7404): 1423.
  15. 15. Ridker PM. Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation, 2003, 107(3): 363-369.
  16. 16. Almagor M, Keren A, Banai S. Increased C-reactive protein level after coronary stent implantation in patients with stable coronary artery disease. Am Heart J, 2003, 145(2): 248-253.
  17. 17. 血脂治療現(xiàn)狀調(diào)查協(xié)作組. 我國(guó)血脂異常治療現(xiàn)狀的調(diào)查. 中華心血管病雜志, 2001, 29(1): 15~17.
  18. 18. Law M, Rudnicka AR. Statin safety: a systematic review. Am J Cardiol, 2006, 97(8A): 52C-60C.
  19. 19. Ucar M, Mjorndal T, Dahlqvist R. HMG-CoA reductase inhibitors and myotoxicity. Drug Saf, 2000, 22(6): 441-457.