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目的探讨经皮冠状动脉介入(PCI)术后人群服用他汀类药物后低密度脂蛋白(LDL)水平达标情况及与复查造影结果的关系(以冠脉造影评分为指标)。方法选取某医院心内科2005-01-2008-01间因冠心病行冠脉造影+支架植入术,术后使用抗血小板类药物及他汀类等药物治疗,9～18月后复查冠脉造影的所有患者共计88名,年龄35～79(61.9±10.2)岁,排除急性心肌梗死,活动性肝病,肌病等临床情况,比较两次冠脉造影前后冠脉预后评分、LDL、空腹血糖、丙氨酸氨基转移酶(ALT)、肌酸激酶水平等指标,其中冠脉造影评分增高者为病变进展组(n=42),降低或不变者为病变未进展组(n=46);根据LDL水平变化分为LDL降低>30%组(n=37),LDL降低<30%组(n=51)。结果根据中国成人血脂异常防治指南,患者中LDL水平总达标率为74.4%。病变未进展组中,LDL降低幅度-0.90mmol/L,降低百分比(29.6±24.5)%,而病变进展组LDL降低幅度为-0.34mmol/L,降低百分比为(9.1±37.0)%,两组比较,差异有统计学意义。与基础ALT水平比较,治疗后ALT水平升高[(25.2±13.8)vs(28.8±15.1)U/L,P=0.039];与基础肌酸激酶水平比较,治疗后肌酸激酶水平明显升高[(83.9±45.3)比(99.0±58.2)U/L,P=0.009]。他汀治疗前后LDL水平降低>30%组中病变无进展者占64.9%,降低<30%组中仅有43.1%(P<0.05)。结论一般治疗剂量的他汀类药物能使大部分患者LDL水平达标;LDL的降低幅度及降低相对水平越大,遏制冠脉病变进展的作用越大;LDL水平降低的相对百分比比绝对值更有临床意义。
Objective To investigate the compliance of low density lipoprotein (LDL) level with statins in patients after percutaneous coronary intervention (PCI) and the relationship with the results of retrospective radiography (coronary angiography score as an index). Methods From January 2005 to January 2008, a coronary angiography with coronary angiography and stent implantation was performed in a department of cardiology of a hospital. Antiplatelet drugs and statins and other drugs were used after the operation. Coronary angiography was performed after 9 to 18 months A total of 88 patients aged 35-79 years old (61.9 ± 10.2) years old, excluding acute myocardial infarction, active liver disease, myopathy and other clinical conditions, coronary angiography compared before and after two coronary prognosis score, LDL, fasting blood glucose, (ALT), creatine kinase and other indexes. Among them, those with higher coronary angiography score were the progression of disease group (n = 42), those with reduced or no change were the non - progressing group (n = 46). According to the change of LDL level, the LDL decreased> 30% (n = 37) and the LDL decreased <30% (n = 51). Results According to the guidelines for the prevention and treatment of dyslipidemia in Chinese adults, the total compliance rate of LDL in patients was 74.4%. In the non-progressing group, the decrease of LDL was -0.90mmol / L (29.6 ± 24.5)%, while the decrease of LDL was -0.34mmol / L and the percentage of decrease was (9.1 ± 37.0)% in both groups Comparison, the difference was statistically significant. Compared with basal level of creatine kinase (ALT), the level of ALT increased after treatment (25.2 ± 13.8 vs 28.8 ± 15.1 U / L, P = 0.039). Compared with basal creatine kinase, the level of creatine kinase [(83.9 ± 45.3) vs (99.0 ± 58.2) U / L, P = 0.009]. Before and after statin treatment, the LDL level was reduced> 30% in the group of lesions without progress accounted for 64.9%, <30% of the group, only 43.1% (P <0.05). Conclusions The general therapeutic dose of statin can make most patients achieve the goal of LDL. The greater the relative decrease and the relative level of LDL, the greater the effect of curbing the progression of coronary artery disease. The relative percentage of decreasing LDL level is more clinical than the absolute value significance.