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目的:探讨急性冠状动脉综合征(ACS)介入术后,以高敏C反应蛋白(hs-CRP)联合低密度脂蛋白胆固醇(LDL-C)作为他汀治疗靶目标的可行性。方法:2007-01-2009-01期间,连续纳入ACS患者400例,随机分为A、B组(每组200例),常规行介入手术,术后每组给予阿托伐他汀40mg/d,口服1个月;此后给予阿托伐他汀20mg/d,口服维持。A组治疗靶目标为LDL-C<2.07mmol/L,B组治疗靶目标为LDL-C<2.07mmol/L且hs-CRP<3mg/L,观察2组LDL-C、hs-CRP指标变化,随访6个月、12个月、18个月主要心血管不良事件(MACE:全因性死亡、非致死性心肌梗死、靶血管再次血运重建)。结果:2组患者基线特征差异无统计学意义;2组在18个月时均达到各自治疗靶目标;2组LDL-C水平差异无统计学意义;hs-CRP在12个月和18个月随访时差异有统计学意义,分别为(5.96±3.51)和(3.85±2.23)mg.L-1(P<0.05),(4.68±2.81)和(2.05±0.91)mg.L-1(P<0.05);在18个月随访时,2组靶血管再次血运重建率和MACE发生率差异有统计学意义,分别为8.6%和3.6%(P<0.05),16.8%和9.7%(P<0.05)。A组发生MACE的概率是B组的1.73倍(HR=1.73,95%CI:1.12～5.27,P=0.025)。结论:ACS介入术后,对于血脂已达标但炎症仍较为活跃患者,hs-CRP和LDL-C双重达标可进一步减少MACE发生,降低残余心血管风险。hs-CRP可能是他汀治疗的另一有效靶目标。
Objective: To investigate the feasibility of using high-sensitivity C-reactive protein (hs-CRP) and low-density lipoprotein cholesterol (LDL-C) as statin targets after acute coronary syndrome (ACS) intervention. METHODS: Between January 2007 and January 2009, 400 consecutive ACS patients were enrolled and randomly assigned to A and B groups (200 in each group). Conventional interventional procedures were performed. Atorvastatin 40 mg / d, Oral for 1 month; thereafter atorvastatin 20mg / d, oral maintenance. The targets of treatment in group A were LDL-C <2.07mmol / L, the targets of treatment in group B were LDL-C <2.07mmol / L and hs-CRP <3mg / L. The changes of LDL-C and hs- , Followed up for 6 months, 12 months and 18 months. Major adverse cardiovascular events (MACE: all-cause death, non-fatal myocardial infarction, target revascularization). Results: There was no significant difference in baseline characteristics between the two groups. Both groups reached their targets at 18 months. There was no significant difference in LDL-C level between the two groups. There was no significant difference between the two groups at 12 and 18 months The differences were statistically significant at follow-up (5.96 ± 3.51 and 3.85 ± 2.23 mg.L-1, P <0.05), (4.68 ± 2.81) and (2.05 ± 0.91) mg.L- <0.05). At 18 months of follow-up, there was significant difference between the two groups in target revascularization rate and MACE incidence (8.6% vs 3.6%, P <0.05), P <0.05). The incidence of MACE in group A was 1.73 times higher than that in group B (HR = 1.73, 95% CI: 1.12-5.27, P = 0.025). CONCLUSIONS: After ACS interventions, hs-CRP and LDL-C double goals may further reduce the occurrence of MACE and reduce the residual cardiovascular risk for those patients whose blood lipids have been achieved but the inflammation is still active. hs-CRP may be another effective target of statin therapy.