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目的探讨增加阿托伐他汀剂量或联合依折麦布对基础剂量阿托伐他汀治疗后出现高残粒样微粒胆固醇(RLP-C)血症患者的疗效。方法选取常规剂量阿托伐他汀(10 mg·d-1)治疗后出现高RLP-C(≥0.13 mmol·L-1)的稳定性冠心病患者共75例,随机分为双倍剂量阿托伐他汀组(20 mg·d-1,n=38)和联合药物组(阿托伐他汀10 mg·d-1+依折麦布10 mg·d-1,n=37)。比较两组进入研究时及6个月治疗后血脂水平及肱动脉血流介导的血管舒张反应(FMD)的变化。结果两治疗组患者血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、RLP-C及C反应蛋白水平均较6月前明显降低;依折麦布联合阿托伐他汀比双倍剂量阿托伐他汀能更有效地降低RLP-C[分别为(-47.7±18.2)%和(-33.3±24.3)%,P<0.01]和提高FMD[分别为(48.5±45.2)%和(28.9±27.8)%,P=0.03]。结论对常规剂量阿托伐他汀治疗后出现高RLP-C血症的患者添加依折麦布有助于降低RLP-C和改善FMD。
Objective To investigate the effect of increasing atorvastatin dose or combining ezetimibe on patients with high remnant microcholesterol (RLP-C) after basic atorvastatin treatment. Methods A total of 75 patients with stable coronary heart disease with high RLP-C (≥0.13 mmol·L-1) after conventional dose of atorvastatin (10 mg · d-1) were randomly divided into two groups: (20 mg · d-1, n = 38) and the combination group (atorvastatin 10 mg · d-1 and ezetimibe 10 mg · d-1, n = 37). The changes of blood lipid level and brachial artery-mediated vasodilation (FMD) were compared between the two groups when they were enrolled in the study and after 6 months of treatment. Results The levels of total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), RLP-C and C-reactive protein in the two treatment groups were significantly lower than those before 6 months; Combination of atorvastatin reduced RLP-C more effectively (-47.7 ± 18.2)% and (-33.3 ± 24.3)%, P <0.01, respectively, and increased FMD more than double-dose atorvastatin (48.5 ± 45.2)% and (28.9 ± 27.8)%, respectively, P = 0.03]. Conclusions The addition of ezetimibe to patients with high RLP-C after conventional dose of atorvastatin can reduce RLP-C and improve FMD.