Spencer C M, Barradell L B
Adis International Limited, Auckland, New Zealand.
Drugs. 1996 Jun;51(6):982-1018. doi: 10.2165/00003495-199651060-00009.
Gemfibrozil improves lipid and apolipoprotein profiles, particularly very low density lipoprotein (VLDL) triglyceride and high density lipoprotein (HDL) cholesterol levels, in patients with dyslipidaemia when administered at a total daily dose of 900 or 1200 mg. As demonstrated by the Helsinki Heart Study, these effects result in a reduction in some risk factors for coronary heart disease (CHD) and also a 34% reduction in the incidence of this disease after 5 years compared with placebo. Limited data suggest that gemfibrozil has beneficial effects on the fibrinolytic system and may slow the progression of atherosclerosis. Gemfibrozil has shown efficacy in the treatment of patients with type IIa, IIb, III, IV or V dyslipidaemia or hypoalphalipoproteinaemia, especially in patients with elevated triglyceride and low HDL cholesterol levels. It is also effective in patients with non-insulin-dependent diabetes mellitus (NIDDM) and dyslipidaemia and has no detrimental effects on glycaemic control. A small number of studies also showed gemfibrozil to be effective for the control of dyslipidaemia associated with renal failure, transplantation, nephrotic syndrome, arterial occlusive disease or systemic lupus erythematosus. However, patients with pre-existing CHD do not appear to derive the same benefits (reduced CHD mortality) from gemfibrozil therapy as these other patients, although results are based on studies of limited size and number. In general, gemfibrozil has at least similar efficacy to bile acid sequestrants and other fibric acid derivatives. Comparisons with HMG-CoA reductase inhibitors show these agents to produce different effects on lipid profiles from gemfibrozil. Thus, gemfibrozil would be expected to be superior in some patients (those with elevated triglyceride or VLDL cholesterol levels), but HMG-CoA reductase inhibitors should have greater benefits in those with elevated low density lipoprotein cholesterol levels. Thus, in patients with elevated triglyceride levels and low HDL cholesterol levels, and, particularly in patients with NIDDM, gemfibrozil is a useful treatment option, which has been shown to reduce the risk of CHD in middle aged men. However, limited available data prevents the accurate comparison of this agent with HMG-CoA reductase inhibitors in patients with this lipid profile.
对于血脂异常患者，当每日总剂量为900或1200毫克时，吉非贝齐可改善血脂和载脂蛋白谱，尤其是极低密度脂蛋白（VLDL）甘油三酯和高密度脂蛋白（HDL）胆固醇水平。正如赫尔辛基心脏研究所示，这些作用可降低一些冠心病（CHD）的危险因素，并且与安慰剂相比，5年后该疾病的发病率降低了34%。有限的数据表明，吉非贝齐对纤溶系统有有益作用，可能会减缓动脉粥样硬化的进展。吉非贝齐已显示出对IIa型、IIb型、III型、IV型或V型血脂异常或低α脂蛋白血症患者有效，尤其是对甘油三酯升高和HDL胆固醇水平低的患者。它对非胰岛素依赖型糖尿病（NIDDM）和血脂异常患者也有效，并且对血糖控制没有不利影响。少数研究还表明，吉非贝齐对控制与肾衰竭、移植、肾病综合征、动脉闭塞性疾病或系统性红斑狼疮相关的血脂异常有效。然而，尽管结果基于规模和数量有限的研究，但已患CHD的患者似乎并未从吉非贝齐治疗中获得与其他患者相同的益处（降低CHD死亡率）。一般来说，吉非贝齐至少与胆汁酸螯合剂和其他纤维酸衍生物具有相似的疗效。与HMG-CoA还原酶抑制剂的比较表明，这些药物对血脂谱的影响与吉非贝齐不同。因此，预计吉非贝齐在某些患者（甘油三酯或VLDL胆固醇水平升高的患者）中更具优势，但HMG-CoA还原酶抑制剂对低密度脂蛋白胆固醇水平升高的患者应具有更大的益处。因此，对于甘油三酯水平升高和HDL胆固醇水平低的患者，尤其是NIDDM患者，吉非贝齐是一种有用的治疗选择，已证明可降低中年男性患CHD的风险。然而，有限的现有数据妨碍了在具有这种血脂谱的患者中将该药物与HMG-CoA还原酶抑制剂进行准确比较。
