Iliadis E A, Rosenson R S
Preventive Cardiology Center, Rush Presbyterian-St. Luke's Medical Center, Chicago, Illinois 60612, USA.
Clin Cardiol. 1999 Jan;22(1):25-8. doi: 10.1002/clc.4960220110.
Combined HMG-CoA reductase inhibitor and fibric acid derivative therapy is often necessary for the effective reduction of concentrations of low-density lipoprotein (LDL) cholesterol and triglycerides in patients with mixed hyperlipidemia; however, the potential risk of myopathy has limited the use of these agents.
This study evaluated long-term safety and efficacy of combined pravastatin and gemfibrozil therapy.
Eighty-three patients with hyperlipidemia were treated with combined pravastatin and gemfibrozil therapy for a median of 44 months (range 9-78 months). Plasma lipids, serum liver function tests, creatinine, and creatinine kinase (CK) levels were measured every 3 to 4 months.
One patient developed myalgia with a normal CK level after 4 months of combination therapy. Three patients had transient elevations in CK levels that ranged from 3 to 5 times the upper limits of "normal" and that returned to normal upon repeat testing. Liver function tests did not change significantly from baseline. In a subset of 26 previously untreated patients, combined pravastatin (mean daily dose 22 mg) and gemfibrozil (mean daily dose 1,154 mg) therapy lowered total cholesterol by 25% (p < 0.001), triglycerides by 53% (p = 0.0001), LDL cholesterol by 14% (p = 0.24), and increased high-density lipoprotein (HDL) cholesterol by 20% (p = 0.012).
Pravastatin and gemfibrozil therapy is safe and efficacious in patients with mixed hyperlipidemia. The long-term safety results are consistent with other reports on follow-up of shorter duration.
对于有效降低混合性高脂血症患者的低密度脂蛋白（LDL）胆固醇和甘油三酯浓度，联合使用HMG-CoA还原酶抑制剂和纤维酸衍生物治疗通常是必要的；然而，肌病的潜在风险限制了这些药物的使用。
本研究评估了普伐他汀和吉非贝齐联合治疗的长期安全性和疗效。
83例高脂血症患者接受普伐他汀和吉非贝齐联合治疗，中位治疗时间为44个月（范围9 - 78个月）。每3至4个月测量血脂、血清肝功能、肌酐和肌酸激酶（CK）水平。
1例患者在联合治疗4个月后出现肌痛，CK水平正常。3例患者CK水平短暂升高，为“正常”上限的3至5倍，再次检测时恢复正常。肝功能检查与基线相比无显著变化。在26例先前未接受治疗的患者亚组中，联合使用普伐他汀（平均每日剂量22 mg）和吉非贝齐（平均每日剂量1154 mg）治疗可使总胆固醇降低25%（p < 0.001），甘油三酯降低53%（p = 0.0001），LDL胆固醇降低14%（p = 0.24），高密度脂蛋白（HDL）胆固醇升高20%（p = 0.012）。
普伐他汀和吉非贝齐联合治疗对混合性高脂血症患者安全有效。长期安全性结果与其他较短随访时间的报告一致。
