阿西莫司联合小剂量阿托伐他汀治疗肾移植术后混合型高脂血症的疗效与安全性

韦星; 蔡明; 李响; 金海龙; 张大伟

doi:10.3969/j.issn.1674-7445.2015.06.009

阿西莫司联合小剂量阿托伐他汀治疗肾移植术后混合型高脂血症的疗效与安全性

doi: 10.3969/j.issn.1674-7445.2015.06.009

100091 北京, 解放军第309医院全军器官移植研究所泌尿一科

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通讯作者:
蔡明, Email:caiming@medmail.com.cn

中图分类号: R617;R589.2
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出版历程
- 收稿日期: 2015-07-12
- 网络出版日期: 2021-01-19
- 刊出日期: 2015-11-15

Therapeutic effect and safety of acipimox combined with small-dose atorvastatin on combined hyperlipidemia after renal transplantation

The First Department of Urology, Organ Transplantation Research Institute of People's Liberation Army, the 309 Hospital of People's Liberation Army, Beijing 100091, China

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Corresponding author: Cai Ming, Email:caiming@medmail.com.cn

摘要

摘要: 目的评价阿西莫司联合小剂量阿托伐他汀治疗肾移植术后混合型高脂血症的疗效及安全性。方法 56例肾移植术后合并混合型高脂血症的患者, 随机分为联合小剂量组[28例, 阿西莫司(250 mg, 每日2次)+阿托伐他汀(10 mg, 每日1次)]和正常剂量组[28例, 阿托伐他汀(20~40 mg, 每日1次)]。比较治疗前及治疗后1、2、3个月血清中总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、天冬氨酸转氨酶(AST)、丙氨酸转氨酶(ALT)、血清肌酐(Scr)、血尿素氮(BUN)、尿酸(UA)、肌酸激酶(CK)等指标, 并记录药物不良反应。结果与治疗前比较, 正常剂量组与联合小剂量组在治疗后TC、TG、LDL-C均下降, HDL-C轻度升高, 差异均有统计学意义(均为P < 0.01)。与正常剂量组比较, 联合小剂量组的TG、LDL-C均较低, HDL-C较高, 差异均有统计学意义(均为P < 0.01)。在治疗前和治疗后各时间点, 正常剂量组与联合小剂量组的ALT、AST、Scr、BUN、UA、CK比较, 差异均无统计学意义(均为P>0.05)。正常剂量组和联合小剂量组的消化系统、神经系统、骨骼肌肉系统、皮肤血管的不良反应发生率比较差异均有统计学意义(均为P < 0.05)。结论阿西莫司联合小剂量阿托伐他汀能安全有效地治疗肾移植术后混合型高脂血症。
- 肾移植 /
- 混合型高脂血症 /
- 阿托伐他汀 /
- 阿西莫司
Abstract: Objective To assess the therapeutic effect and safety of acipimox combined with small-dose atorvastatin on combined hyperlipidemia after renal transplantation. Methods Fifty-six patients complicated with combined hyperlipidemia after renal transplantation were randomized into the combined small-dose group [n=28, acipimox (250 mg, twice a day)+atorvastatin (10 mg, once a day)] and normal dose group [n=28, atorvastatin (20-40 mg, once a day)]. Total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterin (HDL-C), low density lipoprotein cholesterin (LDL-C), aspartate aminotransaminase (AST), alanine aminotransferase (ALT), serum creatinine (Scr), blood urea nitrogen (BUN), uric acid (UA) and creatine kinase (CK) were observed before treatment and 1, 2 and 3 months after treatment. Adverse drug reaction was recorded. Results Compared with those before treatment, TC, TG and LDL-C of the normal dose group and the combined small-dose group decreased after treatment, but HDL-C increased, and the difference had statistical significance (all in P < 0.01). Compared with the normal dose group, TG and LDL-C of the combined small-dose group were lower and HDL-C was higher, and the difference had statistical significance (all in P < 0.01). At each time point before and after treatment, ALT, AST, Scr, BUN, UA and CK of the normal dose group and the combined small-dose group showed no statistically significant difference (all in P>0.05). There was significant difference in the incidence of adverse reactions in the digestive system, nervous system, musculoskeletal system and skin/vascular of the normal dose group and the combined small-dose group (all in P < 0.05). Conclusions Acipimox combined with small-dose atorvastatin can treat combined hyperlipidemia after renal transplantation safely and effectively.
- Renal transplantation /
- Combined hyperlipidemia /
- Atorvastatin /
- Acipimox

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表 1 两组患者治疗前后血脂指标的变化

Table 1. Changes of blood lipid level of patients in two groups before and after treatment

(mmol/L，x±s)
时间	n	TG	TC	HDL-C	LDL-C
治疗前
小剂量组	28	3.12±0.45	6.35±0.54	1.18±0.21	4.21±0.23
正常剂量组	28	3.23±0.18	6.19±0.31	1.16±0.14	4.31±0.19
治疗后1个月
小剂量组	28	2.65±0.33^{a, b}	4.81±0.38^b	1.21±0.19^{a, b}	4.15±0.31^{a, b}
正常剂量组	28	3.19±0.23^b	4.69±0.18^b	1.18±0.22^b	4.27±0.31^b
治疗后2个月
小剂量组	28	2.58±0.21^{a, b}	4.72±0.28^b	1.23±0.10^{a, b}	4.12±0.18^{a, b}
正常剂量组	28	3.21±0.31^b	4.65±0.32^b	1.21±0.31^b	4.22±0.15^b
治疗后3个月
小剂量组	28	2.48±0.27^{a, b}	4.59±0.31^b	1.23±0.24^{a, b}	4.01±0.25^{a, b}
正常剂量组	28	3.20±0.13^b	4.52±0.27^b	1.20±0.25^b	4.17±0.28^b
注：与正常剂量组比较，^aP < 0.01；与同组治疗前比较，^bP < 0.01

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表 2 两组患者治疗前后肝、肾功能和心肌损伤指标的变化

Table 2. Changes of liver function, renal function and myocardial damage indicators of patients in two groups before and after treatment(x±s)

时间	n	ALT(U/L)	AST(U/L)	Scr(μmol/L)	BUN(mmol/L)	UA(μmol/L)	CK(U/L)
治疗前
正常剂量组	28	24±6	22±4	86±3	6.5±1.3	268±11	82±5
小剂量组	28	22±4	22±3	85±4	6.4±1.7	278±9	78±6
治疗后1个月
正常剂量组	28	27±6	25±3	85±4	6.1±2.5	249±8	77±8
小剂量组	28	26±4	24±2	85±5	5.9±1.5	251±9	80±7
治疗后2个月
正常剂量组	28	27±7	25±4	87±4	6.2±2.7	261±9	79±6
小剂量组	28	24±4	23±2	86±4	6.1±2.1	263±7	76±6
治疗后3个月
正常剂量组	28	29±8	24±7	87±3	6.5±1.2	251±13	81±7
小剂量组	28	24±4	23±2.5	86±4	6.3±1.7	271±11	75±9

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参考文献(17)

[1]	He LP, Tang XY, Ling WH, et al. Early C-reactive protein in the prediction of long-term outcomes after acute coronary syndromes: a meta-analysis of longitudinal studies[J]. Heart, 2010, 96(5):339-346. doi: 10.1136/hrt.2009.174912
[2]	乙成成, 刘雯雯, 张颖秋, 等.低密度脂蛋白胆固醇与高密度脂蛋白胆固醇的比值与动脉粥样硬化的关系[J].第二军医大学学报, 2011, 32(2):224-226. http://www.cnki.com.cn/Article/CJFDTOTAL-DEJD201102026.htm Yi CC, Liu WW, Zhang YQ, et al. Relationship of low-and high-density lipoprotein cholesterol with atherosclerosis[J]. Acad J Sec Mil Med Univ, 2011, 32(2):224-226. http://www.cnki.com.cn/Article/CJFDTOTAL-DEJD201102026.htm
[3]	Emerging Risk Factors Collaboration, Erqou S, Kaptoge S, et al. Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality[J]. JAMA, 2009, 302(4):412-423. doi: 10.1001/jama.2009.1063
[4]	Riella LV, Gabardi S, Chandraker A. Dyslipidemia and its therapeutic challenges in renal transplantation[J]. Am J Transplant, 2012, 12(8):1975-1982. doi: 10.1111/j.1600-6143.2012.04084.x
[5]	Takagi H, Umemoto T. Low-density lipoprotein cholesterol-independent effects of statins on coronary artery disease[J]. Am J Cardiol, 2011, 107(2):336. http://cn.bing.com/academic/profile?id=2101184907&encoded=0&v=paper_preview&mkt=zh-cn
[6]	Huisa BN, Stemer AB, Zivin JA. Atorvastatin in stroke: a review of SPARCL and subgroup analysis[J]. Vasc Health Risk Manag, 2010, 6:229-236. http://cn.bing.com/academic/profile?id=2023123197&encoded=0&v=paper_preview&mkt=zh-cn
[7]	Chung YH, Lee YC, Chang CH, et al. Statins of high versus low cholesterol-lowering efficacy and the development of severe renal failure[J]. Pharmacoepidemiol Drug Saf, 2013, 22(6):583-592. doi: 10.1002/pds.v22.6
[8]	Graziano TS, Cuzzullin MC, Franco GC, et al. Statins and antimicrobial effects: simvastatin as a potential drug against staphylococcus aureus biofilm[J]. PLoS One, 2015, 10(5):e0128098. doi: 10.1371/journal.pone.0128098
[9]	刘凤阁, 陈静.降脂通脉胶囊联合阿托伐他汀钙治疗混合型高脂血症疗效观察[J].中国医药导报, 2011, 8(27):71-72. http://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201127032.htm Liu FG, Chen J. Clinical observation of Jiangzhi Tongmai capsule combined with atorvastatin calcium tablets in treating combined hyperlipidemia[J]. Chin Med Her, 2011, 8(27):71-72. http://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201127032.htm
[10]	Fruchart JC, Sacks FM, Hermans MP, et al. Implications of the ACCORD lipid study: perspective from the Residual Risk Reduction Initiative (R(3)i)[J]. Curr Med Res Opin, 2010, 26(8):1793-1797. doi: 10.1185/03007995.2010.489341
[11]	Choe EY, Wang HJ, Kwon O, et al. HMG CoA reductase inhibitor treatment induces dysglycemia in renal allograft recipients[J]. Transplantation, 2014, 97(4):419-425. doi: 10.1097/01.TP.0000437427.04733.ad
[12]	Ivandić E, Bašić-Jukić N. Liver damage caused by atorvastatin and cyclosporine in patients with renal transplant[J]. Acta Med Croatica, 2014, 68(2):175-178. http://cn.bing.com/academic/profile?id=399695850&encoded=0&v=paper_preview&mkt=zh-cn
[13]	Panza GA, Taylor BA, Dada MR, et al. Changes in muscle strength in individuals with statin-induced myopathy:a summary of 3 investigations[J]. J Clin Lipidol, 2015, 9(3):351-356. doi: 10.1016/j.jacl.2015.01.004
[14]	Tsartsalis AN, Dokos C, Kaiafa GD, et al. Statins, bone formation and osteoporosis:hope or hype?[J]. Hormones, 2012, 11(2):126-139. doi: 10.14310/horm.2002.1149
[15]	Hoeger S, Benck U, Petrov K, et al. Atorvastatin donor pre-treatment in a model of brain death and allogeneic kidney transplantation in rat[J]. Ann Transplant, 2012, 17(1):79-85. doi: 10.12659/AOT.882639
[16]	Garcia GG, Harden P, Chapman J, et al. The global role of kidney transplantation[J]. Nephrol Dial Transplant, 2013, 28(8):e1-e5. doi: 10.1093/ndt/gfs013
[17]	赵瑞虹, 宁均, 郭蔚莹, 等.烟酸与辛伐他汀联合治疗对动脉粥样硬化患者脂联素及高敏C反应蛋白的影响[J].中国老年学杂志, 2011, 31(4):576-578. http://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ201104010.htm Zhao RH, Ning J, Guo WY, et al. The influence of nicotinic acid and simvastatin combined treatment on adiponectin and high-sensitivity c-reactive protein in patients with atherosclerosis[J]. Chin J Gerontol, 2011, 31(4):576-578. http://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ201104010.htm