East C, Bilheimer D W, Grundy S M
University of Texas Southwestern Medical Center, Dallas.
Ann Intern Med. 1988 Jul 1;109(1):25-32. doi: 10.7326/0003-4819-109-1-25.
To compare the efficacy of gemfibrozil and colestipol with gemfibrozil and lovastatin in patients with familial combined hyperlipidemia.
A prospective, randomized trial.
An outpatient clinical research center in a tertiary care center.
Seventeen patients with familial combined hyperlipidemia documented by studies of first-degree relatives; nine patients with type 2b hyperlipoproteinemia, and eight patients with type 4 hyperlipoproteinemia.
Baseline lipid, lipoprotein, and apolipoprotein levels were obtained during control periods on diet alone and on gemfibrozil therapy. Patients then received gemfibrozil and colestipol or gemfibrozil and lovastatin in a randomized order.
In patients with type 2b hyperlipoproteinemia, gemfibrozil alone significantly reduced total cholesterol by 11%, and low density lipoprotein (LDL)-apolipoprotein B by 18%, did not change LDL-cholesterol, and raised high density lipoprotein (HDL)-cholesterol levels by 26%. Addition of either colestipol or lovastatin reduced LDL-cholesterol levels by 17% and 25%, respectively, compared to gemfibrozil alone. However, colestipol mitigated the HDL-cholesterol raising effect of gemfibrozil and did not further reduce LDL-apolipoprotein B levels. In contrast, addition of lovastatin caused an additional reduction of LDL-apolipoprotein B 19% compared with gemfibrozil alone. In patients with type 4 hyperlipoproteinemia, gemfibrozil alone reduced triglycerides by 40%, raised HDL-cholesterol by 26%, and increased LDL-cholesterol levels by 29%. The addition of either colestipol or lovastatin reduced LDL-cholesterol levels by 34% and 33%, respectively (compared with gemfibrozil alone), but greater reductions of LDL-apolipoprotein B (30% with lovastatin compared with 15% with colestipol, compared with gemfibrozil alone), and increases in HDL-cholesterol levels (8% increase with lovastatin compared with 10% decrease with colestipol, compared to gemfibrozil alone) were seen with the lovastatin combination.
Although gemfibrozil with either colestipol or lovastatin favorably altered lipoprotein levels in patients with hypertriglyceridemia and familial combined hyperlipidemia, the combination of gemfibrozil and lovastatin appeared superior overall.
比较吉非贝齐与考来烯胺联用和吉非贝齐与洛伐他汀联用治疗家族性混合性高脂血症患者的疗效。
一项前瞻性随机试验。
一家三级医疗中心的门诊临床研究中心。
经一级亲属研究确诊的17例家族性混合性高脂血症患者；9例Ⅱb型高脂蛋白血症患者和8例Ⅳ型高脂蛋白血症患者。
在仅采用饮食控制和吉非贝齐治疗的对照期内，测定基线血脂、脂蛋白和载脂蛋白水平。然后患者随机接受吉非贝齐与考来烯胺或吉非贝齐与洛伐他汀治疗。
在Ⅱb型高脂蛋白血症患者中，单用吉非贝齐可使总胆固醇显著降低11%，低密度脂蛋白（LDL）-载脂蛋白B降低18%，LDL-胆固醇无变化，高密度脂蛋白（HDL）-胆固醇水平升高26%。与单用吉非贝齐相比，加用考来烯胺或洛伐他汀分别使LDL-胆固醇水平降低17%和25%。然而，考来烯胺减弱了吉非贝齐升高HDL-胆固醇的作用，且未进一步降低LDL-载脂蛋白B水平。相比之下，加用洛伐他汀与单用吉非贝齐相比，使LDL-载脂蛋白B额外降低19%。在Ⅳ型高脂蛋白血症患者中，单用吉非贝齐可使甘油三酯降低40%，HDL-胆固醇升高26%，LDL-胆固醇水平升高29%。加用考来烯胺或洛伐他汀与单用吉非贝齐相比，分别使LDL-胆固醇水平降低34%和33%，但洛伐他汀联用组使LDL-载脂蛋白B降低幅度更大（与单用吉非贝齐相比，洛伐他汀组降低30%，考来烯胺组降低15%），且HDL-胆固醇水平升高幅度更大（与单用吉非贝齐相比，洛伐他汀组升高8%，考来烯胺组降低10%）。
虽然吉非贝齐与考来烯胺或洛伐他汀联用均可使高甘油三酯血症和家族性混合性高脂血症患者的脂蛋白水平得到有利改变，但吉非贝齐与洛伐他汀联用总体上似乎更优。
