新疆医科大学学报

目的探讨瑞舒伐他汀联合依折麦布对急性冠脉综合征(ACS)合并糖耐量异常(IGT)患者血脂、糖代谢的影响及用药安全性。方法收集2017年9月-2018年12月因ACS在新疆维吾尔自治区中医院心脏重症医学科(CCU)收治且合并IGT的患者共192例,随机分为观察组和对照组,每组各96例,共完成随访180例(观察组90例,对照组90例)。观察指标:(1)治疗前和治疗6个月、12个月后总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平;(2)入院第6天及治疗第12个月空腹血糖(FBG)、糖负荷后2 h血糖(2 hPPG)、糖化血红蛋白(HbAlc%)、新发糖尿病数;(3)治疗12个月过程中是否出现:转氨酶升高>3 IU/L、服药后肌酸激酶升高>5 IU/L、急性肾功能不全、新发肿瘤性疾病。结果 (1)两组治疗前TC、HDL-C、LDL-C水平差异均无统计学意义(P>0.05);治疗6个月、12个月后,两组TC、HDL-C、LDL-C水平均较治疗前有统计学差异(P均<0.05)。治疗6个月、12个月后,治疗组与对照组TC、LDL-C水平差异具有统计学意义(P<0.05)。(2)两组入院第6天与治疗12个月后FBG、2 hPPG、HbAlc%比较差异无统计学意义(P>0.05);治疗12个月后分别与本组入院第6天相比,FBG、HbAlc%差异无统计学意义(P>0.05),但2 hPPG差异具有统计学意义(P<0.05)。治疗组新发糖尿病7例,占7.8%,对照组6例,占6.7%,两组新发糖尿病发生率差异无统计学意义(P>0.05)。(3)两组治疗12个月内均未出现肝酶升高、肾功能异常变化、新发肿瘤疾病,对照组发生1例肌酶升高病例,两组不良反应发生情况差异无统计学意义(P>0.05)。结论瑞舒伐他汀联合依折麦布较单用瑞舒伐他汀在ACS合并IGT病例中具有更好的降脂效果,且两种降脂策略对糖代谢的影响及不良反应方面均无明显差异。

Objective To investigate the effect and safety of rosuvastatin combined with ezetimibe on blood lipid and glucose metabolism in patients with acute coronary syndrome(ACS) and impaired glucose tolerance(IGT). Methods A total of 192 patients with ACS and IGT in CCU of Xinjiang Uygur Autonomous Region Hospital of Traditional Chinese Medicine from September 2017 to December 2018 were randomly divided into observation group and control group, with 96 cases in each group, and 180 cases were followed up(90 cases in the observation group and 90 cases in the control group). Observation indicators:(1) the levels of total cholesterol(TC), low-density lipoprotein cholesterol(LDL-C), high-density lipoprotein cholesterol(HDL-C) before and after 6 and 12 months of the treatment;(2) fasting blood glucose(FBG), 2-hour blood glucose(2 hppg), glycosylated hemoglobin(HbAlc) and the number of new onset diabetes mellitus(DM) were observed before the treatment, the 6 th day and 12 th month after treatment;(3) after 12 months of treatment, whether transaminase increase >3×IU/L, creatine kinase increase >5×IU/L, acute renal insufficiency and new tumor disease occurred. Results(1) There was no significant difference in the TC, HDL-C and LDL-C levels between the two groups before the treatment(P>0.05). The levels of TC, HDL-C, LDL-C after 6 months of the treatment and after 12 months of the treatment in the two groups were statistically significant(P<0.05). After 6 months and 12 months of the treatment, the levels of TC and LDL-C in the treatment group and the control group were significantly different(P<0.05).(2) There were no significant differences in FBG, 2 hPPG and HbAlc between the two groups on the 6 th day and 12 th month after admission(P>0.05). There were no significant differences in FBG and HbAlc between the two groups after 12 months of the treatment and 6 days of admission(P>0.05), but there was significant difference in 2 hPPG(P<0.05).(3) There was no liver enzyme elevation, abnormal renal function change, new tumor disease in the two groups within 12 months. There was 1 case of muscle enzyme elevation in the control group, and there was no significant difference in adverse reactions between the two groups(P>0.05). Conclusion Rosuvastatin combined with ezetimibe has better lipid-lowering effect than rosuvastatin alone in the ACS patients with IGT, and there is no significant difference between the two lipid-lowering strategies on glucose metabolism and the occurrence of adverse reactions.