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1、阿托伐他汀非延续性治疗对冠心病伴高脂血症病人血脂及内皮功能【摘要】目的通过观察冠心病伴高脂血症病人使用阿托伐他汀治疗前、后及中途停药后的血脂、血清一氧化氮(NO)、血浆内皮素(ET)水平的变化,探讨他汀类药物在冠心病防治中延续性治疗的意义。方法从门诊、住院病人中选择冠心病伴高脂血症病人50例作为研究对象,给予阿托伐他汀20mg口服治疗,分别于清晨空腹抽取服药前、服药4周后、停药2周时的肘静脉血,检测血总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、NO、
2、ET的水平。结果阿托伐他汀治疗4周后病人TC、LDL水平明显降低,停用阿托伐他汀2周后,所有病人的TC和LDL水平较停药前升高,但仍低于服药前水平(F=233.58、95.71,P<0.05);服药4周血清NO水平明显升高,然而停用阿托伐他汀2周后,NO水平明显降低,甚至低于服药前水平(F=364.98,P<0.05);服药4周血浆ET明显降低,停药2周ET水平则明显冋升(F=98.39,P<0.05)。结论阿托伐他汀对冠心病伴高脂血症病人的血管内皮功能有明显改善作用,但当突然停止阿托伐他汀治疗2周后
3、对病人的血脂水平及内皮功能改善作用明显减弱,甚至导致血管内皮功能的进一步恶化。[关键词】冠状动脉硬化;高脂血症;阿托伐他汀;血管内皮功能[ABSTRACT]ObjectiveToassesstheeffectsofatorvastainontherapyofcoronaryheartdisease(CHD)byobservingthebloodfat,serumNO,andplasmaETbefore,afterandhalfwaywithdrawalofmedication・MethodsFifty
4、CHDpatientswithhyperlipemiawereenrolledfromoutpatientsandinpatients・Theyweregiven20mgatorvastatinorally.Fastingbloodwastakenfromulnarveinbeforemedication,fourweeksaftertherapy,andtwoweeksafterdrugwithdrawa1.Totalcholesterol(TC),triacylglycerol,highdensi
5、tylipoproteincholesterol(HDL),lowdensitylipoproteincholesterol(LDL),nitrogenmonoridum(NO),andendothelin(ET)levelsweredetected.ResultsTCandLDLlevelsdeclinedmarkedlyafterfourweeksofatorvastintreatment,theaboveitemsroseaftertwoweeksofdiscontinue,butstilllo
6、werthanthatbeforemedication,(F二233.58,95.71;P<0.05).ForNO,whichroseobviouslyafterfourweekmedication,anddecreaseddramaticallytwoweeksafterdrugwithdrawalandevenlowerthanthatbeforetreatment(F=364.98,P<0.05)・ForET,whichloweredsignificantlyafterfourweekmedic
7、ation,andreturnedmanifestlytwoweeksafterdrugwithdrawal(F=98.39,P〈0.05).ConclusionAtorvastainiseffectiveinimprovingthefunctionofbloodvesselendothelium(BVE),buttheimprovementwasdecreasedobviouslywhensuddenwithdrawalofthemedicinefortwoweekswhichmayresultin
8、evenworseimpactonBVEfunction.[KEYWORDS]Coronaryarteriosclerosis:Hyperlipidemia;Atorvastain;Vesselendothelialfunction他汀类药物是目前临床应用最为广泛的调脂药物,具有显著的抗动脉粥样硬化的作用。目前认为,他汀类药物防治冠心病的作用机制除了调节血脂外,尚有非降脂机制,其中与血管内皮功能的改善密切相关。近年来有关他汀类药物对内皮功能影响的临床研究