耿丹 刘翔

摘 要 目的：探討阿托伐他汀用药剂量对老年血脂正常冠心病患者预后的影响。方法：将收集老年血脂正常冠心病患者42例，随机均分为观察组和对照组各21例，均给予硫酸氢氯吡格雷片（75 mg/次，1次/d）、阿司匹林肠溶片（100 mg/次，1次/d）和阿托伐他汀（治疗组20 mg/次，1次/d，观察组40 mg/次，1次/d）治疗，共6个月。比较两组治疗前后动脉粥样硬化斑块积分、血清炎性因子水平及用药期间心血管不良事件和不良反应发生情况。结果：治疗后，观察组斑块积分显著低于对照组（P<0.05）；血清白细胞介素-6、超敏C反应蛋白水平均显著低于对照组（P<0.05）。观察组心血管事件总发生率为4.76%（1/21），显著低于对照组的28.57%（6/21，P<0.05）。观察组不良反应总发生率为19.05%（4/21），对照组为23.81%（6/21），组间差异无统计学意义（P>0.05）。结论：大剂量阿托伐他汀治疗老年血脂正常冠心病疗效显著，在抑制粥样硬化斑块、改善炎症状态和降低心血管事件发生风险中更具临床优势。

关键词 冠心病；血脂；阿托伐他汀；用药剂量

中图分类号：R541.4 文献标志码：A 文章编号：1006-1533（2018）24-0023-02

Effect of atorvastatin dosage on prognosis of coronary heart disease in elderly patients with normal blood lipids

GENG Dan， LIU Xiang（Department of Pharmacy of Xiangyaping Mine Cooperative Hospital of Pingxiang， Pingxiang 337000， Jiangxi Province， China）

ABSTRACT Objective： To investigate the effect of atorvastatin dosage on the prognosis of coronary heart disease in elderly patients with normal blood lipids. Methods： Forty-two patients with normal blood lipids and coronary heart disease were collected and randomly divided into an observation group and a control group with 21 cases each. All patients were given clopidogrel bisulfate tablet（75 mg/time， once a day）， aspirin enteric-coated tablet（100 mg/time， once a day） and atorvastatin（the treatment group 20 mg/ time， once a day， the observation group 40 mg/ times， once a day） treatment for 6 months. Atherosclerotic plaque score， serum inflammatory factors， adverse cardiovascular events and adverse reactions were compared between the two groups before and after treatment. Results： After treatment， plaque score in the observation group was significantly lower than that in the control group（P<0.05）. Serum interleukin -6 and high sensitivity C reactive protein levels were significantly lower in the observation group than those in the control group（P<0.05）. The total incidence of cardiovascular events in the observation group was 4.76%（1/21）， which was significantly lower than that in the control group 28.57%（6/21， P<0.05）. The total incidence of adverse reactions was 19.05%（4/21） in the observation group and 23.81%（6/21） in the control group and there was no significant difference between the two groups（P>0.05）. Conclusion： High dose atorvastatin is effective in the treatment of coronary heart disease in elderly patients with normal blood lipids. It has more clinical advantages in inhibiting atherosclerotic plaque， improving inflammation and reducing the risk of cardiovascular events.

KEY WORDS coronary heart disease； blood lipid； atorvastatin； dosage

冠心病的治疗一直是临床研究热点，如何有效控制患者血脂水平、稳定粥样硬化斑块、改善内皮功能是提高患者预后的关键[1]。他汀类药物在冠心病治疗中效果明确，在稳定斑块、抗炎、预防急性冠脉综合征等方面效果显著，但该药物的最佳用药剂量仍需进一步研究确定[2-3]。本文报道采用不同剂量阿托伐他汀对老年血脂正常的冠心病患者预后的影响，以期为临床用药提供参考。

1 资料与方法

1.1 一般资料

收集2017年1月至9月接诊的老年血脂正常的冠心病患者42例，均经常规冠状动脉造影结合实验室指标确诊，符合本研究用药指征，按照随机数字表法将患者均分为观察组和对照组各21例。……