柯博熙++陆蓉

[摘要] 目的 探討动脉粥样硬化性心血管疾病（ASCVD）患者应用瑞舒伐他汀（RSV）2周及3个月降脂幅度及降脂达标率，研究最佳治疗方案，并观察安全性。 方法 选择2015年2月～2016年4月入住我院307例患者，按数字表法随机分为RSV 10 mg组和20 mg组，治疗2周和治疗3个月后进行监测总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）下降水平，及肝肾功能、心肌酶谱的变化，观察药物副反应。 结果 两组患者基线水平的差异无统计学意义（P>0.05）。RSV 10 mg组和RSV 20 mg组治疗2周后与基线比较，TC降低幅度均值达23.1%、29.8%（χ2=2.987，P=0.003），LDL-C降低幅度均值达29.4%、37.8%（χ2=12.105，P<0.001），LDL-C达标率为5.3%、19.2%（χ2=13.733，P<0.001），说明两组间治疗2周后TC、LDL-C降脂幅度、及LDL-C达标率比较，差异具有统计学意义。两组治疗3个月后再与基线比较，TC降低幅度均值达33.4%、45.1%（χ2=8.353，P<0.001），LDL-C降低幅度均值达46.5%、54.8%（χ2=10.222，P<0.001），LDL-C达标率为49.7%、70.5%（χ2=13.921，P<0.001），说明两组间治疗3个月后TC、LDL-C降脂幅度、及LDL-C达标率比较，差异具有统计学意义。 结论 我国ASCVD患者RSV 20 mg qd治疗2周及3个月后，降脂幅度、达标率明显高于RSV 10 mg qd，并且比较安全。

[关键词] 动脉粥样硬化性心血管疾病；瑞舒伐他汀；低密度脂蛋白胆固醇；达标率

[中图分类号] R743.3 [文献标识码] B [文章编号] 1673-9701（2017）10-0035-04

Effect of rosuvastatin on lipid-regulating ability of atherosclerotic cardiovascular disease

KE Boxi1 LU Rong2

1.Department of Neurology， Taizhou Central Hospital in Zhejiang Province， Taizhou 318000， China； 2.Department of Anesthesiology， Taizhou Central Hospital in Zhejiang Province， Taizhou 318000， China

[Abstract] Objective To study the lipid-lowering range，lipid-lowering standard-reaching rate after application of rosuvastatin（RSV） for 2 weeks and 3 months in atherosclerotic cardiovascular disease（ASCVD） patients， and to study the best treatment regimen and observe the safety. Methods 307 patients admitted in our hospital from February 2015 to April 2016 were chosen and randomly divided into RSV 10 mg group and RSV 20 mg group.After treatment for 2 weeks and 3 months total cholesterol（TC）， decrease levels of low density lipoprotein cholesterol（LDL-C）， and the changes of liver，kidney function，and myocardial enzymes were monitored.And drug side effects were observed. Results There was no significant difference in the baseline level between the two groups（P>0.05）. Compared with baseline， the mean reduction range of TC in the RSV10mg group and RSV 20 mg group after 2 weeks of treatment was 23.1% and 29.8% ，respectively， （χ2=2.987，P=0.003）. The reduction range of LDL-C in the RSV10mg group and RSV 20 mg group was 29.4% and 37.8%（χ2=12.105， P<0.001）， with the standard-reaching rate of 5.3%、19.2%（χ2=13.733，P<0.001）， indicating that there was significant difference in TC， LDL-C lipid-lowering range and LDL-C standard-reaching rate between the two groups after the treatment for 2 weeks. Compared with baseline，the mean reduction range of TC in the RSV10 mg group and RSV 20mg group after 3 months of treatment was 33.4% and 45.1%（χ2=8.353， P<0.001）. The reduction range of LDL-C in the two groups was 46.5% and 54.8%（χ2=10.222， P<0.001）. And the standard-reaching rate of LDL-C in the two groups was 49.7%，70.5%（χ2=13.921， P<0.001）， indicating that there was significant difference in TC， LDL-C lipid-lowering range and LDL-C standard-reaching rate between the two groups after the treatment for 3 months. Conclusion The range of lipid-lowering and standard-reaching rate of ASCVD patients after the treatment of RSV 20 mg qd for 2 weeks and 3 months were significantly higher than those after the treatment of RSV 10 mg qd for 2 weeks and 3 months， and the former treatment was safe.

[Key words] Atherosclerotic cardiovascular disease； Rosuvastatin； Low density lipoprotein cholesterol； Standard-reaching rate

动脉粥样硬化性心血管疾病（atherosclerotic cardiovascular disease，ASCVD）：新增加了缺血性卒中或短暂性脑缺血发作（transient ischemic attack，TIA），其他包括急性冠状动脉综合征、稳定性冠心病、血运重建术后、缺血性心肌病、外周动脉粥样硬化病（peripheral atherosclerotic disease，PAD）等[1]。ASCVD的发病率和死亡率逐年增多，已成为全世界死亡的第一位，急需减少ASCVD的发生风险[2]。低密度脂蛋白胆固醇（low density lipoprotein cholesterol，LDL-C）是发生动脉粥样硬化的最重要因素，与ASCVD发生显著相关[3]。瑞舒伐他汀（rosuvastatin，RSV）是降低ASCVD的首选药物之一。《2016中国成人血脂异常防治指南》把诊断为ASCVD归为极高危人群，要求他汀治疗3个月后，使LDL-C基线值下降50%，或者降至1.8 mmol/L以下[3]，本研究以此为目标探讨不同剂量RSV的LDL-C达标率，现报道如下。

1 资料与方法

1.1 一般资料

选择2015年2月～2016年4月入住我院307例诊断为ASCVD患者，年龄45～80岁，依据ASCVD诊断标准[4]。排除标准：①2周内经他汀治疗；②严重脏器功能不全；③肿瘤或全身免疫性疾病；④……