作者：鲁津津，胡敏，刘煜芃

单位：

1.徐州医科大学附属沭阳医院心内科2.浙江省杭州市第一人民医院药剂科

Units：

1.Department of Cardiology, the Affiliated Shuyang Hospital of Xuzhou Medical University, Shuyang 223600, China 2.Department of Pharmaceutical Sciences, Hangzhou First People's Hospital, Hangzhou 310000, China

关键词：

高胆固醇血症; 心血管高危; 依折麦布; 瑞舒伐他汀; 治疗结果;

Keywords：

　Hypercholesterolemia; High cardiovascular risk; Ezetimibe; Rosuvastatin; Treatment outcome

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.155

Funds：

浙江省医药卫生科技项目（2020KY231）

摘要：

目的 探讨依折麦布联合瑞舒伐他汀治疗高胆固醇血症合并心血管高危患者的临床效果。方法 选择2021年1月至2022年2月徐州医科大学附属沭阳医院收治的高胆固醇血症合并心血管高危患者104例为研究对象，采用随机数字表法将患者分为依折麦布组（n=52）与联合用药组（n=52）。依折麦布组患者给予依折麦布口服，联合用药组患者给予依折麦布联合瑞舒伐他汀口服，两组均治疗12周。比较两组治疗前后血脂指标（LDL-C、HDL-C、三酰甘油、总胆固醇）、脂蛋白相关磷脂酶A2(Lp-PLA2)水平、颈动脉硬化指标[颈动脉内径、斑块Crouse积分、颈动脉内膜中层厚度（CIMT）]，比较两组治疗期间不良反应及不良心血管事件发生情况。结果 治疗后，两组LDL-C、三酰甘油、总胆固醇、Lp-PLA2水平分别低于本组治疗前，HDL-C水平分别高于本组治疗前（P<0.05）；治疗后，联合用药组LDL-C、三酰甘油、总胆固醇、Lp-PLA2水平低于依折麦布组，HDL-C水平高于依折麦布组（P<0.05）。治疗后，两组颈动脉内径分别大于本组治疗前，斑块Crouse积分分别低于本组治疗前，CIMT分别小于本组治疗前（P<0.05）；治疗后，联合用药组颈动脉内径大于依折麦布组，斑块Crouse积分低于依折麦布组，CIMT小于依折麦布组（P<0.05）。治疗期间，两组不良反应总发生率、不良心血管事件总发生率比较，差异无统计学意义（P>0.05）。结论 依折麦布联合瑞舒伐他汀可有效改善高胆固醇血症合并心血管高危患者血脂代谢，降低Lp-PLA2水平，延缓颈动脉硬化进展，且安全性高。

Abstract：

Objective To investigate the clinical effects of ezetimibe combined with rosuvastatin in the treatment of patients with hypercholesterolemia and high cardiovascular risk. Methods A total of 104 patients with hypercholesterolemia and high cardiovascular risk admitted to the Affiliated Shuyang Hospital of Xuzhou Medical University from January 2021 to February 2022 were selected as the research subjects, and the patients were divided into ezetimibe group (n=52) and combined medication group (n=52) by random number table method. Patients in ezetimibe group were given ezetimibe, patients in combined medication group were given ezetimibe combined with rosuvastatin, all were treated for 12 weeks. Lipid indexes (LDL-C, HDL-C, triglyceride, total cholesterol) , lipoprotein-associated phospholipase A2 (Lp-PLA2) level, carotid atherosclerosis indexes [carotid artery diameter, plaque Crouse score, carotid intima-media thickness (CIMT) ] before and after treatment were compared between the two groups, and the incidence of adverse reactions and adverse cardiovascular events during the treatment were compared between the two groups. Results After treatment, LDL-C, triglyceride, total cholesterol, Lp-PLA2 levels in the two groups were lower than those before treatment, HDL-C level was higher than that before treatment, respectively (P < 0.05) ; LDL-C, triglyceride, total cholesterol, Lp-PLA2 levels in combined medication group were lower than those in ezetimibe group, HDL-C level in combined medication group was higher than that in ezetimibe group (P < 0.05) . After treatment, carotid artery diameter in the two groups was greater than that before treatment, plaque Crouse score was lower than that before treatment, CIMT was smaller than that before treatment, respectively (P < 0.05) ; carotid artery diameter in combined medication group was greater than that in ezetimibe group, plaque Crouse score was lower than that in ezetimibe group, CIMT was smaller than that in ezetimibe group (P < 0.05) . There was no significant difference in the incidence of adverse reactions and adverse cardiovascular events during the treatment (P > 0.05) . Conclusion Ezetimibe combined with rosuvastatin can effectively improve the blood lipid metabolism of patients with hypercholesterolemia and high cardiovascular risk, reduce the level of Lp-PLA2, delay the progression of carotid atherosclerosis, and has high safety.

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