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目的探讨阿托伐他汀40mg/d在急性冠状动脉综合征(ACS)患者行经皮冠状动脉介入术(PCI)后强化降脂治疗的效果,不同剂量阿托伐他汀的血脂降低程度及血脂降低的时间曲线,不良反应和对急性临床心脏事件的影响。方法92例PCI术后的ACS患者随机分配为阿托伐他汀常规剂量(10mg/d)A组和大剂量阿托伐他汀(40mg/d)B组各46例,观察用药后1,4,12,24周两组的结果。结果失访率A组6·5%(3例),B组8·6%(4例)。(1)两组患者用药后1~4周为丙氨酸转氨酶(ALT)出现异常的高峰期,1周异常例数A组20·9%比B组45·2%(P=0·011)发生比例少,多数ALT<正常值的3倍,观察后恢复正常;而A组有2例(4·7%)、B组有3例(7·1%)的患者ALT>正常值的3倍,需停药;两组各有2例肾功能异常。(2)A、B组患者的血脂下降率,在给药12周后TC下降率12·3%比21·7%(P=0·042),给药24周后TC下降率11·1%比23·4%(P=0·005),低密度脂蛋白(LDL)下降率10·0%比29·5%(P=0·000),以及24周LDL≤1·8mmol/L比例为19·5%比51·2%(P=0·005),差异均有统计学意义。(3)随访期内A、B两组心脏事件差异无统计学意义。结论(1)阿托伐他汀40mg/d是安全的。(2)服用阿托伐他汀40mg/d可显著提高ACS患者PCI术后调脂的达标率,特别是LDL降至1·8mmol/L及以下的比例更高。
Objective To investigate the effects of atorvastatin 40 mg / d on lipid-lowering therapy after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS). The effects of different doses of atorvastatin on the reduction of blood lipids and the lowering of serum lipids Time curve, adverse reactions and effects on acute clinical cardiac events. Methods Ninety-two patients with ACS undergoing PCI were randomly assigned to receive atorvastatin at a dose of 10 mg / day and group A at a high dose of atorvastatin at 40 mg / 12,24 weeks results of the two groups. Results The follow-up rate was 6.5% (3 cases) in group A and 8.6% (4 cases) in group B. (1) Abnormal peak of alanine aminotransferase (ALT) occurred in both groups 1 to 4 weeks after treatment. The number of abnormalities in one week was 20.9% in group A and 45.2% in group B (P = 0.01 1) ) Had less ALT <3 times of the normal value, and returned to normal after observation. There were 2 cases (4.7%) in group A and 3 cases (7.1%) in group B with ALT> normal 3 times, to be discontinued; two groups each have 2 cases of renal dysfunction. (2) The declining rates of TC in group A and group B were 12.3% and 21.7% after 12 weeks of treatment (P = 0.0442), respectively. After 24 weeks of treatment, TC decreased rate was 11.1 % (P = 0.005), low density lipoprotein (LDL) decreased by 10.0% and 29.5% (P = 0.000) The proportions were 19.5% and 51.2%, respectively (P = 0.005), the differences were statistically significant. (3) There was no significant difference in heart events between A and B groups during the follow-up period. Conclusion (1) Atorvastatin 40mg / d is safe. (2) Atorvastatin 40mg / d can significantly improve the compliance rate of lipid-lowering in patients with ACS after PCI, especially the proportion of LDL dropped to 1.8mmol / L and below.