急性冠脉综合征患者PCI术后他汀类药物使用依从性及对预后的影响

孙丽丽，黄淑田

摘要：目的探讨急性冠脉综合征(ACS)患者PCI术后他汀类药物使用依从性及其对预后的影响。方法选择在我院心内科就诊的399例PCI术后的ACS患者，随机分为A组(辛伐他汀20 mg/d组)，B组(阿托伐他汀20 mg/d组)，C组(瑞舒伐他汀10 mg/d组)。对患者入院临床资料，出院3月、6月、12月肝功能及心肌酶、空腹血糖、血脂、依从性、心脏不良事件(MACE)进行统计学分析，分析他汀类药物在ACS患者PCI术后使用的依从性及对预后的影响。结果A、B、C组患者出院3月他汀使用依从率分别为98.43%、95.28%、88.19%，6月为97.81%、93.43%、85.4%，12月为97.03%、92.59%、77.78%，3组用药依从率随时间延长逐渐降低(P<0.0167)。A、B、C组患者出院3月、6月、12月TC、TG、LDL-C水平均呈下降趋势，入院时、出院后3月、6月、12月分别与前一时间段比较差异有统计学意义(P<0.05)。3组LDL-C<1.8 mmol/L水平患者人数随着治疗时间的延长逐渐增多。3组出院3月达标率分别为9.45%、18.29%19.26%，出院6个月分别为30.71%、36.50%、39.26%，出院12个月分别为51.18%、61.31%、63.70%，比较差异有统计学意义(P<0.05)。MACE事件随治疗时间延长呈下降趋势；LVEF随治疗时间延长呈上升趋势。结论ACS患者PCI术后使用他汀类药物可改善预后，减少MACE事件发生，且长时间使用安全。

关键词：急性冠脉综合征；PCI术；他汀类药物；依从性；预后

中图分类号：R543R255

通讯作者：黄淑田，E-mail：huangshutian9@126.com

收稿日期：(2014-09-23)

Impacts of Compliance and Prognosis of Statin in Patients with Acute Coronary Syndrome after PCI

Sun Lili，Huang Shutian

The Second Hospital，Shanxi Medical University，Taiyuan 030001，Shanxi，China

Corresponding Author：Huang Shutian

AbstractObjectiveTo explore the impacts of compliance and prognosis of statin use in patients with acute coronary syndrome(ACS) after percutaneous coronary intervention (PCI).MethodsThree hundreds and ninety-nine patients with ACS after PCI in our hospital were selected and randomly divided into three goups：Group A treated with simvastatin 20 mg/d，group B treated with atorvastatin 20 mg/d，and group C treated with rosuvstatin 10 mg/d.The clinical data，and discharged liver enzymes，fasting glucose，lipids，compliance and major adverse cardiac events (MACE) after patient get out of hospital for 3 months，6 months and 12 months were observed.The impacts about compliance and prognosis of statin use in patients with acute coronary syndrome after PCI.ResultsThe compliance rate were 98.43%，95.28%，88.19% in group A，97.81%，93.43%，85.4% in group B，97.03%，92.59%， 77.78% in group C after 3 months，6 months and 12 months.The compliance rates were gradually reduced，and there were significant differences (P<0.0167) in three groups.The levels of serum total cholesterol，triglyceride and low density lipoprotein-eholesterol were gradually decreased，and there was significant difference compared with the previous period.The number of LDL-C level less than 1.8 mmol/L in three groups was gradually increased，and the compliance rates were 9.45%，18.29，%19.26% after 3 months，30.71%，36.50%，39.26% after 6 months，and 51.18%，61.31%，63.70% after 12 months in group A，group B and group C，and there were significant differences (P<0.0167).The MACE was decreased，and left ventricular ejection fraction was increased，and there was no statistical significantce.ConclusionACS patients after PCI using statins may improve outcomes and reduce MACE events，and prolonged use is safe.

Key words：acute coronary syndrome；percutaneous coronary intervention；tatin；compliance；prognosis

作者单位：山西医科大学第二临床医院(太原 030001)

急性冠脉综合征(ACS)是冠心病的一种急症，包括不稳定型心绞痛(UA)、急性心肌梗死(AMI)，其中AMI又包括非ST段抬高性心肌梗死(NSTEMI)和ST段抬高性心肌梗死(STEMI)，目前治疗ACS的手段主要有药物治疗、溶栓治疗和介入治疗(PCI)，无论选择哪种治疗方法，药物治疗都是基石。AMYDA-ACS研究表明[1]，PCI术前使用大剂量他汀可减少围术期心肌梗死的风险和降低不良心血管事件。但PCI术后他汀的使用指南未有明确说明。本研究旨在探讨ACS患者PCI术后他汀类药物使用依从性及对预后的影响。

1资料与方法

1.1研究对象选择2011年6月—2013年3月在我院心内科住院行PCI治疗的ACS患者，随机分为3组，辛伐他汀20 mg组(A组)127例，年龄35岁～81岁(58.3岁±9.8岁)。阿托伐他汀20 mg组(B组)137例，年龄35岁～83岁(59.1岁±10.2岁)。……