标题：不同剂量阿托伐他汀对ACS合并慢性肾病非冠状动脉介入治疗患者心肾功能的影响

      作者：王萍，曾敏，郑茵，蒙绪卿，符秀虹，何扬利，刘肖君    (海南省人民医院医疗保健中心，海南 海口 570311)

      卷次： 2017年28卷9期

      【摘要】 目的 观察不同剂量的阿托伐他汀治疗急性冠脉综合征(ACS)合并慢性肾病非冠状动脉介入治疗患者对其心肾功能的保护作用及药物安全性。方法 选择2015年4月至2016年4月在海南省人民医院医疗保健中心住院的ACS合并慢性肾病非冠状动脉介入治疗的患者180例，采用随机双盲的原则分成观察组(n=90)和对照组(n=90)，两组在原有冠心病、肾功能不全治疗的基础上，观察组给予强化阿托伐他汀(40 mg/d)治疗，对照组给予常规剂量阿托伐他汀(20 mg/d)治疗。治疗 3个月后，检测并比较两组患者治疗前及治疗后的甘油三酯(TC)、总胆固醇(CHOL)、低密度脂蛋白(LDL-C)、血清超敏 C反应蛋白(hs-CRP)、血肌酐(Scr)、血尿素氮(BUN)、肾小球滤过率(eGFR)等指标，观察两组治疗后其他临床不良事件发生情况。结果 治疗 3个月后，两组患者的 TC、CHOL、LDL-C水平较治疗前均降低，差异均有统计学意义(P<0.05)，但两组患者治疗后的TC、CHOL、LDL-CH水平比较，差异均无统计学意义(P>0.05)；两组患者治疗后的血清hs-CRP水平均低于治疗前，且治疗组较对照组下降明显，差异均有统计学意义(P<0.05)；两组患者治疗后的Scr、BUN水平均较治疗前降低，eGFR较治疗前升高，差异均有统计学意义(P<0.05)，但两组患者治疗后的Scr、BUN、eGFR比较，差异均无统计学意义(P>0.05)；临床随访3个月后，两组患者的全因死亡率、急性心力衰竭、再发心绞痛和快速性心律失常等临床不良事件发生率比较差异均无统计学意义(P>0.05)。结论 不同剂量阿托伐他汀通过调脂及抗氧化、抗炎等非降脂作用，降低肾功能相关指标，使肾小球滤过率上升，从而使肾功能不全进展延缓。对于ACS合并慢性肾病非冠状动脉介入患者，强化阿托伐他汀对心肾功能的保护作用更有效。
      【关键词】 强化阿托伐他汀；急性冠脉综合征；慢性肾病；非冠状动脉介入
      【中图分类号】 R442.8 【文献标识码】 A 【文章编号】 1003—6350（2017）09—1403—04

Effects of different dosages of atorvastatin on cardiac and renal function in patients with acute coronarysyndrome combined with chronic kidney disease via non-coronary intervention.
WANG Ping, ZENG Min, ZHENGYin, MENG Xu-qing, FU Xiu-hong, HE Yang-li, LIU Xiao-jun. Medical Health Care Center, Hainan Provincial People’sHospital, Haikou 570311, Hainan, CHINA
【Abstract】 Objective To observe the effect of different dosages of atorvastatin on cardiac and renal functionand drug safety in patients with acute coronary syndrome (ACS) combined with chronic kidney disease via non-coronaryintervention. Methods According to the randomized double-blind principle, 180 ACS patients with kidney disease vianon-coronary intervention from April 2015 to April 2016, in Hainan Provincial People's Hospital medical center, were di-vided into observation group (n=90) and control group (n=90). On the basic treatment of kidney dysfunction and heartdisease, the observation group was given intensive atorvastatin (40 mg/d), and the control group was given a convention-al dose of atorvastatin (20 mg/d). After 3 months of treatment, indexes were compared between the two groups beforeand after treatment, including triglyceride (TC), total cholesterol (CHOL), low density lipoprotein (LDL-C), serumhigh-sensitivity C reactive protein (hs-CRP), serum creatinine (Scr), blood urea nitrogen (BUN), glomerular filtrationrate (eGFR), and clinical adverse events were observed in the two groups after treatment. Results After 3 months oftreatment, TC, CHOL and LDL-C levels of the two groups were decreased significantly compared with before treatment(P<0.05), but the levels showed no significant differences between the two groups (P>0.05). The serum level of hs-CRPafter treatment was lower than that before treatment in both two groups, and the decrease in the observation group wasmore significant than that in the control group (P<0.05). Scr and BUN levels after treatment were decreased significantlyin both two groups and eGFR was increased significantly (P<0.05), but there were no significant differences in Scr,BUN and eGFR between two groups (P>0.05). A 3-month clinical follow-up indicated that there was no significant dif-ference between the two groups in the incidence of events (P>0.05), including acute heart failure and all-cause mortality,recurrent angina and arrhythmia. Conclusion Different dosages of atorvastatin can reduce the renal function related in-dexes and increase the glomerular filtration rate by lipid regulation, anti-oxidation, anti-inflammatory effect, and othernon-lipid-lowering effects. For patients with ACS combined with chronic kidney disease, the effect of atorvastatin on re-nal function is more effective.
      【Key words】 Intensive atorvastatin; Acute coronary syndrome; Chronic kidney disease; Non-coronary intervention·论 著·doi:10.3969/j.issn.1003-6350.2017.09.009