Athyros V G, Mikhailidis D P, Papageorgiou A A, Symeonidis A N, Pehlivanidis A N, Bouloukos V I, Elisaf M
Atherosclerosis Unit, Aristotelian University, Hippocration Hospital, 49 Konstantinoupoleos St, Thessaloniki, 546 42, Greece.
J Clin Pathol. 2004 Jul;57(7):728-34. doi: 10.1136/jcp.2003.012989.
Little is known about statins in the prevention of dyslipidaemia induced renal function decline. The secondary coronary heart disease (CHD) prevention GREACE study suggested that dose titration with atorvastatin (10-80 mg/day, mean dose 24 mg/day) achieves the national cholesterol educational programme treatment goals and significantly reduces morbidity and mortality, compared with usual care.
To report the effect of statin on renal function compared with untreated dyslipidaemia in both treatment groups.
METHODS/RESULTS: All patients had plasma creatinine values within the reference range < 115 micro mol/litre (13 mg/litre). The on study creatinine clearance (CrCl), as estimated (for up to 48 months) by the Cockroft-Gault formula, was compared within and between treatment groups using analysis of variance to assess differences over time. Patients from both groups not treated with statins (704) showed a 5.2% decrease in CrCl (p < 0.0001). Usual care patients on various statins (97) had a 4.9% increase in CrCl (p = 0.003). Structured care patients on atorvastatin (783) had a 12% increase in CrCl (p < 0.0001). This effect was more prominent in the lower two quartiles of baseline CrCl and with higher atorvastatin doses. After adjustment for 25 predictors of all CHD related events, multivariate analysis revealed a hazards ratio of 0.84 (confidence interval 0.73 to 0.95; p = 0.003) with every 5% increase in CrCl.
In untreated dyslipidaemic patients with CHD and normal renal function at baseline, CrCl declines over a period of three years. Statin treatment prevents this decline and significantly improves renal function, potentially offsetting an additional factor associated with CHD risk.
关于他汀类药物在预防血脂异常引起的肾功能下降方面，人们了解甚少。继发性冠心病（CHD）预防GREACE研究表明，与常规治疗相比，阿托伐他汀剂量滴定（10 - 80毫克/天，平均剂量24毫克/天）可实现国家胆固醇教育计划的治疗目标，并显著降低发病率和死亡率。
报告与未治疗的血脂异常相比，他汀类药物对两个治疗组肾功能的影响。
方法/结果：所有患者的血浆肌酐值均在参考范围内<115微摩尔/升（13毫克/升）。使用方差分析评估治疗组内和组间的差异，通过Cockcroft - Gault公式估算（长达48个月）的研究期间肌酐清除率（CrCl）。两组未接受他汀类药物治疗的患者（704例）的CrCl下降了5.2%（p<0.0001）。接受各种他汀类药物治疗的常规治疗患者（97例）的CrCl增加了4.9%（p = 0.003）。接受阿托伐他汀治疗的结构化护理患者（783例）的CrCl增加了12%（p<0.0001）。这种效果在基线CrCl的较低两个四分位数和较高阿托伐他汀剂量时更为显著。在对所有冠心病相关事件的25个预测因素进行调整后，多变量分析显示，CrCl每增加5%，风险比为0.84（置信区间0.73至0.95；p = 0.003）。
在基线肾功能正常的未治疗的冠心病血脂异常患者中，CrCl在三年期间下降。他汀类药物治疗可防止这种下降并显著改善肾功能，可能抵消与冠心病风险相关的另一个因素。
