谭志晖　郭瑞威　谭志胜

[摘要] 他汀類药物，即3-羟基-3甲基戊二酰辅酶A（HMG-CoA）还原酶抑制药，是目前最有效的降脂药物，不仅能强效地降低总胆固醇（TC）和低密度脂蛋白（LDL），而且能一定程度上降低三酰甘油（TG），还能升高高密度脂蛋白（HDL）水平，被称为较全面的调脂药。他汀类药物的作用机制是通过竞争性抑制内源性胆固醇合成限速酶 HMG-CoA还原酶，阻断细胞内羟甲戊酸代谢途径，使细胞内胆固醇合成减少，从而反馈性刺激细胞膜表面LDL受体数量和活性增加，使血清胆固醇清除增加水平降低，临床上主要用于降低胆固醇尤其是低密度脂蛋白胆固醇，治疗动脉粥样硬化，现已成为冠心病预防和治疗的最有效药物。近年来，研究发现他汀类药物具有多方面非降脂作用，其中包括抑制动脉粥样硬化与血栓形成，还具有缓解器官移植后的排异反应、治疗骨质疏松症、抗肿瘤、抗老年痴呆等多种作用。而本文结合急性心肌梗死的发病机制，阐述他汀类药物对急性心肌梗死的作用机制，并就其对急性心肌梗死的系列作用进行综述，为临床用药提供理论依据和指导。

[关键词] 他汀类药物；急性心肌梗死；综述；临床指导

[中图分类号] R541 [文献标识码] A [文章编号] 1673-7210（2018）07（b）-0021-04

Clinical application and research progress of statins in the treatment of acute myocardial infarction

TAN Zhihui1 GUO Ruiwei2 TAN Zhisheng2 LIU Dan3 GUO Shuo4

1.Department of Geriatrics， Kunming General Hospital of Chengdu Military Command， Yunnan Province， Kunming 650032， China； 2.Department of Cardiology， Kunming General Hospital of Chengdu Military Command， Yunnan Province， Kunming 650032， China； 3.Department of General Medicine， Kunming Tongren Hospital， Yunnan Province， Kunming 650032， China； 4.Department of Internal Medicine， Kunming Guangfu Hospital， Yunnan Province， Kunming 650032， China

[Abstract] Statins， the 3- hydroxyl -3 methyl amyl two acyl coenzyme A （HMG-CoA） reductase inhibitor， are the most effective lipid lowering drugs at present. It can not only reduce the total cholesterol （TC） and the low density lipoprotein （LDL）， but also reduce the TG and increase the density lipoprotein （HDL） to a certain extent， it is called a comprehensive lipid-lowering drug. The mechanism of statins is to synthesize the enzyme HMG-CoA reductase by competitive inhibition of endogenous cholesterol， blocking the intracellular pathway of hydroxymethylene valerate metabolism， reducing the cholesterol synthesis in cells， and increasing the number and activity of LDL receptor on the surface of the membrane on the membrane， so that serum cholesterol is increased， which is mainly used to reduce cholesterol， especially low density lipoprotein cholesterol in clinic， and to treat atherosclerosis， is the most effective drug for the prevention and treatment of coronary heart disease. In recent years， it has been found that statins have many non lipid-lowering effects， including inhibition of atherosclerosis and thrombosis， remission of rejection after organ transplantation， treatment of osteoporosis， antitumor， and anti Alzheimer′s disease. But， combined with the pathogenesis of acute myocardial infarction， this article expounded the mechanism of statins on acute myocardial infarction， and summarized its serial role in acute myocardial infarction， so as to provide theoretical basis and guidance for clinical medication.

[Key words] Statins； Acute myocardial infarction； Review； Clinical guidance

急性心肌梗死（AMI）是由冠状动脉粥样硬化引起的心肌缺血造成的，严重影响着患者的心脏功能。他汀类药物在心血管疾病的治疗中具有显著的降脂作用，而且还具有心血管内保护作用，可有效干预动脉血管的粥样硬化。……