急性冠脉综合征合并轻中度肾功能不全患者他汀降脂治疗的安全性肖.DOC

急性冠脉综合征合并轻中度肾功能不全患者他汀降脂治疗的安全性 肖华，洪长江，林朴卿，雷刚，邱健 广州军区广州总医院心血管内科 广东广州 510010 摘要：目的 观察急性冠脉综合征合并轻中度肾功能不全患者的中他汀降脂治疗的安全性，了解上述患者在强效降脂的同时是否加重肾功能恶化。方法：纳入2010年9月-2012年7月本院心内科病房的急性冠脉综合征合并轻中度肾功能不全患者96例，随机分为瑞舒伐他汀组（A组）及阿托伐他汀治疗组（B组），其中A组49例，B组47例，两组均接受急诊介入治疗并按照冠心病治疗指南标准给予治疗。A组给予10mg的瑞舒伐他汀治疗，B组给予阿托伐他汀20mg治疗。分别于入院时、1月、3月、6月，测定ALT、CK、Cr和血脂水平，并计算eGFR。于介入术后2天复查Cr及计算eGFR。结果：两组于1月时均能显著性降低患者的血脂水平，3个月达最强效，两组之间无明显差异；两组中各有1例因ALT升高3倍而改用依折麦布，CK、eGFR在治疗前后及两组中无明显区别。两组中分别有1例患者于术后2天eGFR轻度下降，1月后恢复至术前。结论：急性冠脉综合征合并轻中度肾功能不全患者中应用瑞舒伐他汀和阿托伐他汀进行强化降脂治疗是安全有效的。 关键词：急性冠脉综合征，轻中度肾功能不全， 瑞舒伐他汀，阿托伐他汀 Safety of potent cholesterol-lowering on coronary heart disease with mild to moderate renal insufficiency patients XIAO Hua,，CHANG Jiang-hong, LIN Pu-qing，LEI Gang，QIU Jian General Hospital of Guangzhou Military Command of PLA, Guangzhou, 510010, China Abstract Objective: To evaluate the effects and safety of potent cholesterol-lowering on patients with coronary heart disease with mild to moderate renal insufficiency. Methods: A total of 96 subjects with acute coronary syndromes and renal failure from September 2010 to July 2012 of our hospital were randomly allocated to two groups. 49 patients in Group A received Rosuvastatin（10mg/d） treatment , 47 patients in Control Group（Group B）received Atorvastatin（20mg/d）therapy. All patients were underwent percutaneous coronary intervention(PCI). The level of Cr was test and eGFR was calculated in 2 days after PCI. The parameters of lipid profile, CK, ALT, Cr and eGFR were studied in admission and follow by1,3, 6 months. Results: Results obtained from the study, clearly indicate that all statins have significant effect on lowering of LDL-C, TC and TG levels in 1 months and the highest lowering in 3 months. There is 1 patient change to Ezetimibe in each group because of ALT elevating 3 folds. The levels of CK, eGFR have no significant difference after treatment and in two groups. There was one patient with declined eGFR after PCI in each group and recovery in 1 month after. Co