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目的:研究瑞舒伐他汀对急性冠状动脉综合征(ACS)伴发轻中度肾功能不全患者的影响,了解其在强效降脂的同时是否加重肾功能恶化。方法:对79例ACS伴发肾功能不全患者,分别给予瑞舒伐他汀10 mg治疗(瑞舒伐他汀组,39例)和辛伐他汀40 mg或阿托伐他汀20 mg治疗(其他他汀组,40例)。分别于治疗前,治疗后1个月、3个月和6个月,测定谷丙转氨酶(ALT)、肌酸激酶(CK)、肌酐(Cr)和血脂水平,并计算估算肾小球滤过率(eGFR)。所有患者均进行冠状动脉介入手术,同时于术后3 d复查Cr及计算eGFR。结果:与组内术前比较,2组治疗后1个月血脂水平均显著降低,于3个月时达最强效(均P<0.05),但2组间各时点比较均差异无统计学意义。2组中各有1例因ALT升高>3倍而改用依折麦布。CK在2组内治疗后各时间点均较术前显著降低(均P<0.05);而ALT、Cr和eGFR在2组内治疗前后及2组间比较均差异无统计学意义。2组中各有1例患者于介入术后3 d eGFR轻度降低,1个月后均恢复至术前水平。结论:瑞舒伐他汀可强效、安全降低ACS伴发轻中度肾功能不全患者的血脂水平,对肾功能无影响。
AIM: To investigate the effect of rosuvastatin on patients with acute coronary syndrome (ACS) accompanied by mild to moderate renal insufficiency and to find out whether it aggravates renal dysfunction while decreasing blood pressure. Methods: A total of 79 ACS patients with renal insufficiency were treated with rosuvastatin 10 mg (rosuvastatin, 39) and simvastatin 40 mg or atorvastatin 20 mg (other statins , 40 cases). The levels of ALT, CK, creatinine (Cr) and blood lipid were measured before treatment, 1 month, 3 months and 6 months after treatment, and the glomerular filtration rate Rate (eGFR). All patients underwent coronary artery intervention. Cr was also examined at 3 days after operation and eGFR was calculated. Results: Compared with preoperative group, the level of blood lipid decreased significantly at 1 month after treatment in both groups, reaching the most potent at 3 months (all P <0.05), but there was no statistical difference between the two groups Significance of learning. One patient in each group switched to ezetimibe by ALT elevation> 3-fold. CK was significantly lower than preoperative at each time point after treatment in both groups (all P <0.05), while there was no significant difference in ALT, Cr and eGFR between the two groups before and after treatment and between the two groups. One patient in each group had a slight decrease in eGFR 3 days after PCI and returned to preoperative level after 1 month. Conclusion: Rosuvastatin can effectively and safely reduce blood lipid levels in ACS patients with mild to moderate renal insufficiency, and has no effect on renal function.