[他汀类药物用于与急性心肌梗死相关的血脂异常]

Smajić Elnur, Kusljugić Zumreta, Baraković Fahir, Divković Katarina, Hukić-Suljkanović Nedzada, Mrsić Denis, Hujdurović Senada

Klinika za Interne bolesti, Univerzitetski klinicki centar Tuzla.

Med Arh. 2004;58(2 Suppl 1):21-3.

Long time ago lipids increased in blood have been known as risk factor for atherosclerosis that causes coronary heart disease among which myocardial infarction is the most complicated. Aim were to present the lipids status structure in patients with acute myocardial infarction and on the basis of that to suggest corresponding statin in treatment. Our research involved 202 patients with acute myocardial infarction, patients were both gender and from 37 to 89 year. Out of total number of patients, 100 of them were with anterior myocardial infarction (group I) and 102 with inferior myocardial infarction (group II). Whole cholesterol, low density lipoproteins, high density lipoproteins and triglycerides were followed. Hi square test and variance analysis were used to prove statistically significant difference. In the sample of group I increased LDL was found in 92 patients and increased TGL in 46 patients while decreased HDL was found in 61 patients. In the sample of group II increased LDL was found in 64 patients, increased TGL in 44 patients, while decreased HDL was found in 51 patients. We analysed the next combinations in both groups: LDL > with HDL <; LDL > with TGL >; HDL < with TGL >; LDL >, TGL > with HDL <. Combination decreased HDL with increased TGL was found in group I in 5 patients, and in group II in 12 patients. Other combinations in both groups were similarly values. On the basis of the obtained results we found statistically significant difference between the two groups of patients. Patients in group I have more frequently increased values of LDL in comparison to patients in group II (p < 0.00005). In patients in group II who had decreased HDL and increased TGL statistically significant difference was found in comparison to the patients in group I (p < 0.02). On the basis of the obtained results and up to now studies on statins effects we suggest Atorvastatin for treatment the patients with anterior myocardial infarction, increased LDL with normal values of HDL and Simvastatin for treatment the patients with inferior myocardial infarction, decreased HDL.

很久以前，血液中脂质升高就被认为是动脉粥样硬化的危险因素，动脉粥样硬化会引发冠心病，其中心肌梗死最为严重。目的是呈现急性心肌梗死患者的脂质状态结构，并在此基础上建议相应的他汀类药物用于治疗。我们的研究涉及202例急性心肌梗死患者，患者性别不限，年龄在37至89岁之间。在全部患者中，100例为前壁心肌梗死（I组），102例为下壁心肌梗死（II组）。对总胆固醇、低密度脂蛋白、高密度脂蛋白和甘油三酯进行跟踪监测。采用卡方检验和方差分析来证明统计学上的显著差异。在I组样本中，92例患者低密度脂蛋白升高，46例患者甘油三酯升高，61例患者高密度脂蛋白降低。在II组样本中，64例患者低密度脂蛋白升高，44例患者甘油三酯升高，51例患者高密度脂蛋白降低。我们分析了两组中的以下组合：低密度脂蛋白升高且高密度脂蛋白降低；低密度脂蛋白升高且甘油三酯升高；高密度脂蛋白降低且甘油三酯升高；低密度脂蛋白升高、甘油三酯升高且高密度脂蛋白降低。I组中有5例患者出现高密度脂蛋白降低且甘油三酯升高的组合，II组中有12例患者出现该组合。两组中的其他组合数值相似。根据所得结果，我们发现两组患者之间存在统计学上的显著差异。与II组患者相比，I组患者的低密度脂蛋白升高值更为常见（p < 0.00005）。与I组患者相比，II组中高密度脂蛋白降低且甘油三酯升高的患者存在统计学上的显著差异（p < 0.02）。根据所得结果以及目前关于他汀类药物作用的研究，我们建议使用阿托伐他汀治疗前壁心肌梗死、低密度脂蛋白升高且高密度脂蛋白值正常的患者，使用辛伐他汀治疗下壁心肌梗死、高密度脂蛋白降低的患者。