【摘要】 目的 探讨冠状动脉粥样硬化性心脏病(冠心病)高危患者体内胆固醇合成水平与吸收水平的相关性及不同合成吸收水平患者对他汀类药物的反应性。方法 收集2009年5月至2010年4月山西省心血管病医院收治的冠心病高危患者159例,给予阿托伐他汀20 mg,1次/d,顿服,共治疗4周。分别测定治疗前后总胆固醇、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、三酰甘油、角鲨烯、谷固醇水平,并计算角鲨烯/总胆固醇比值(10~2×mmol/mo1)和谷固醇/总胆固醇比值(10~2×mmol/mo1)。根据角鲨烯/总胆固醇比值把患者分为低合成组(≤17,39例)、较低合成组(>17~66,39例)、较高合成组(>66~131,41例)和高合成组(>131,40例);根据谷固醇/总胆固醇比值分为低吸收组(≤138,39例)、较低吸收组(>138~164,40例)、较高吸收组(>164~202,40例)和高吸收组(>202,40例)。分析不同合成吸收水平患者对他汀类药物的反应性。结果 男性和女性年龄、吸烟及饮酒比例、HDL-C和角鲨烯水平比较[(54±10)岁比(58±8)岁,38.0%(27/71)比3.4%(3/88),19.7%(14/71)比0.0%(0/88),(1.4±0.3)mmol/L比(1.5±0.3)mmol/L,(0.42±0.05)mg/ml比(0.58±0.07)mg/ml],差异均有统计学意义(均P<0.05),其余指标差异均无统计学意义(均P>0.05)。低吸收组,胆固醇低合成、较低合成、较高合成和高合成者分别占12.8%(5/39)、15.8%(6/39)、30.8%(12/39)、41.0(16/39);高吸收组分别占35.0%(14/40)、37.5%(15/40)、30.0%(8/40)、7.5%(3/40),2组比较差异有统计学意义(P<0.01)。随着吸收水平的升高,合成高者逐渐减少,随着合成水平的升高,吸收高者逐渐减少(P<0.01)。低合成组他汀类药物治疗后仅38.5%(15/39)合成水平降低,而高合成组82.5%(33/40)合成水平降低,2组比较差异有统计学意义(P<0.01);随着合成水平的升高,使用他汀类药物治疗后合成水平降低的人数逐渐增多(P<0.01)。低吸收组治疗后合成水平降低69.2%(27/39),高吸收组降低62.5%(25/40),2组比较差异有统计学意义(P=0.035);随着吸收水平的升高,使用他汀类药物后合成水平降低的人数逐渐减少(P=0.033)。结论 在冠心病高危患者中,胆固醇合成与吸收存在负反馈调节。胆固醇合成水平越高对他汀类药物的反应性越好,而吸收水平越高,反应性越差。更多还原

【Abstract】 Objective To investigate the correlations between synthesis and absorption of cholesterol in population with high risks of coronary atherosclerosis heart disease and the reactivity to statin drugs of the patients.Methods Totally 159 subjects with high risks of coronary atherosclerosis heart disease from May 2009 to April2010 were enrolled and given atorvastatin(20 mg,1 time/d) for 4 weeks.The levels of total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),triacylglycerol and squalene,sitoesterol,squalene/TC and sitoesterol/TC were determined before and after treatment.According to the ratio of squalene/TC,the subjects were divided into very low synthesis group(≤17,33 cases),low synthesis group(>17-66,40 cases),high synthesis group(>66-131,40 cases) and very high synthesis group(>131,40 cases);according to ratio of sitoesterol/TC,the subjects were divided into very low absorption group(≤138,33 cases),low absorption group(>138-164,40 cases),high absorption group(>164-202,40 cases) and very high absorption group(>202,40 cases).The general data of the subjects were analyzed,and the reactivity to statin drugs were compared among groups.Results The age,proportions of smoker and drinker,levels of HDL-C and squalene were significantly differently between males and females[(54±10)years vs(58±8)years,38.0%(27/71)vs 3.4%(3/88),19.7%(14/71)vs 0.0%(0/88),(1.4±0.3)mmol/L vs(1.5±0.3)mmol/L,(0.42±0.05)mg/ml vs(0.58±0.07)mg/ml](P<0.05),the rest of the index had no statistical significance difference(P>0.05).the subjects of very low synthesis,low synthesis,high synthesis and very high synthesis accounted for 12.8%(5/39),15.8%(6/39),30.8%(12/39),41.0(16/39);in very low absorption group and 35.0%(14/40),37.5%(15/40),30.0%(8/40),7.5(3/40)in very high absorption group;there were significant difference between the two groups(P<0.01),with increase of synthesis,proportion of high absorption was decreased.Similarly,with increase of absorption,propotion of high synthesis was decreased(P<0.01).After treatment with statin,the synthesis of 38.5%(15/39) subjects in very low synthesis group and of 82.5%(33/40) subjects in very high synthesis group was reduced,with significant difference between the two groups(P<0.01);with increased of synthesis,the propotion of subjects with reduced synthetic levels was gradually increased(P<0.01).After treatment with statin,the synthesis of 69.2%(27/39)subjects in very low absorption group and of 62.5%(25/40)subjects in very high absorption group was reduced,with significant difference between the two groups(P=0.035);with increased of absorption,the propotion of subjects with reduced synthetic levels was gradually decreased(P=0.033).Conclusions In population with high-risk of coronary heart disease,there is a negative feedback regulation mechanism between cholesterol synthesis and absorption;the higher cholesterol synthesis,the better reactivity to statin,but it shows the opposite tendency for cholesterol absorption.更多还原