老年女性急性心肌梗死患者应用辛伐他汀强化治疗的临床研究

Intensive simvastatin therapy for elderly female patients with acute myocardial infarction

摘要:

目的探讨老年女性急性心肌梗死患者早期应用辛伐他汀40 mg/d的有效性及安全性。方法对第四军医大学西京医院心内科2006年1月至2008年12月的221例老年女性急性心肌梗死患者于入院24 h内给予辛伐他汀40 mg/d,患者平均住院(8.27±1.67)d。对出院时低密度脂蛋白胆固醇(LDL-C)<2.0 mmol/L,谷丙转氨酶(ALT)或谷草转氨酶(AST)升高超过正常值3倍以上的患者服用剂量减半,即辛伐他汀20 mg/d。比较用药前、出院时及随访治疗期间血脂指标、高敏C反应蛋白(hs-CRP)及肝功能变化情况。结果治疗后总胆固醇、LDL-C比治疗前均有显著降低,其中LDL-C由(3.18±1.02)mmol/L下降至出院时的(2.19±2.00)mmol/L,随访3个月时进一步下降到(1.49±0.79)mmol/L;高密度脂蛋白胆固醇(HDL-C)由(1.56±0.41)mmol/L下降到出院时的(1.25±0.28)mmol/L,至随访3个月时升至(1.75±1.85)mmol/L。辛伐他汀治疗前、出院时及随访1个月时hs-CRP分别为(48.92±46.39)、(9.70±18.25)和(2.63±2.18)mg/L。出院时ALT>120 U/L有24例(10.9%),AST>120 U/L3例(1.4%)。共175例患者返院随访复查。随访1个月时ALT>120 U/L仅1例;随访3个月时无ALT>120 U/L的患者。结论老年女性急性心肌梗死患者早期应用辛伐他汀40 mg/d治疗是有效和安全的。

Abstract:

Objective To assess the safety and efficacy of 40mg daily simvastatin for the elderly female patients with acute myocardial infarction(AMI).Methods A total of 221 elderly female patients with AMI admitted to our hospital from Jan 2006 to Dec 2008 were assigned to simvastatin 40mg daily within 24h of hospitalization and continued till 6 months after discharge.Patients with LDL-C<2mmol/L or increased liver enzyme level at discharge received dose of reduced simvastatin,20mg daily.Lipid profiles,high-sensitive C-reactive protein(hs-RP) and liver enzyme level were measured at admission,discharge and 1,3 and 6 months after discharge.Results LDL-C was continuously decreased(mmol/L(3.18±1.02) at admission,(2.19±2.00) at discharge and(1.49±0.79) at 3 months after discharge).HDL-C was decreased from(1.56±0.41)mmol/L to(1.25±0.28)mmol/L at discharge,then increased to(1.75±1.85)mmol/L at 3 months after discharge.Total cholesterol(TC) and triglyceride(TG) were also significantly decreased from admission to discharge.hs-CRP level significantly decreased from admission to discharge and at 3 months after discharge(mg/L(48.92±46.39) vs(9.70±18.25) vs(2.63±2.18)).Increased ALT>120 U/L were found in 24(10.9%),AST>120 U/L were found in 3(1.4%) patients at discharge.There was still a patient with increased ALT>120 U/L at 1 month after discharge and returned to normal at 3 months after discharge.Conclusion Intensive simvastatin therapy with a dose of 40mg daily is safe and effective for the elderly female patients with AMI.