| Objective: Acute coronary syndrome(ACS)is a severe and acute clinical event in heart disease(CHD).The major pathogenesis of the majority ACS is the coronary artery thrombosis lead by unstable plaque rupture or erosion of the atherosclerosis.Although the effective reperfusion therapy can reduce the mortality,these patients are still at high risk of ischemic events and death.In the perioperative and postoperative blood lipid management for a long time,statins is still a first-line drug,being the foundation of treatment.In recent years the concept of strengthening lipid was put forward in the international blood lipid management,while the elderly using statins expert consensus was put forward combining with the characteristics of nationality in our country.Intensive statin therapy can not only largely reduce the level of serum LDL-C and the stranded lipoprotein in the artery wall,but also defense plaque rupture and oxidation-inflammation.As the wide and intensive statin application,concerns about the safety increased,and new diabetes risk associated with statins gradually raised attention of doctors,in addition to the common liver function damage and myopathy.The purpose of this present study was to investigate the effect of different doses of atorvastatin on glycosylated hemoglobin in acute coronary syndrome(ACS)patients.Methods:This was a randomized controlled trail.Total 90 acute coronary syndrome patients,who underwent percutaneous coronary intervention in the department of cardiology,the Second Hospital of Hebei Medical University during2015.11 to 2016.10,were enrolled.30 in low-dose atorvastatin group(20mg/day),30 in middle-dose atorvastatin group(40 mg/day),and 30 in high-dose atorvastatin group(80 mg/day).one month later,if LDL cholesterol of patients treated with 40 mg and 80 mg,reach the target,the dose turned to20mg;else the dose was 40 mg.The patients primarily treated with 20 mg keep the dose.We collected the Low-density lipoprotein-cholesterol(LDL-C),Alanine aminotransferase(ALT),Creatine kinase(CK),Glycosylated hemoglobin(HbA1c)of patients before treated with atorvastatin,at one month and at three mouth,compared with LDL-C,LDL-C target rates,ALT,CK,HbA1 c before and after treatment.The Statistical Package for the Social Sciences(SPSS)17.0 software was used for statistical analysis,and the level of statistical significance was set at P<0.05.The results of measurement date in accordance with are expressed as mean ±SD values.Comparison of the multiple samples that meet homogeneity of variance test will be analyzed by analysis of variance,if the difference was statistically significant the date will be analyzed by SNK-q test.Comparison of the date at different time in a same group will be analyzed by paired t test.The results of count date will be analyzed by chi-square test.Results:1 Comparison of the general clinical date of each group patients: The baseline character of three groups(low-dose group,middle-dose group,high-dose group)had no statistically difference.2 Comparison of the serum HbA1 c before and after the treatment: the serum HbA1 c of three groups(low-dose group,middle-dose group,high-dose group)after the one month treatment was on the trend of increase(5.94±0.39,5.80±0.42,5.86±0.50 VS 6.04±0.42,5.91±0.32,5.97±0.45),but there was not statistically significance difference(P>0.05).The serum HbA1 c of three groups(low-dose group,middle-dose group,high-dose group)after the three months treatment was statistically higher than the index before treatment(5.94±0.39,5.80±0.42,5.86±0.50 VS 6.07±0.41,5.98±0.32,6.08±0.61),and there was statistically significance difference(P<0.01),without statistically significance difference between the three groups(0.13±0.33,0.17±0.39,0.23±0.35)(P>0.05).3 Comparison of the plasma LDL-C before and after the treatment: the plasma LDL-C of there groups(low-dose group,middle-dose group,high-dose group)after the one month treatment was lower than the index before treatment(2.85±0.62,3.01±0.55,3.20±0.75 VS 2.36±0.56,2.28±0.60,2.00±0.34),and there was statistically significance difference(P<0.01).The comparison of the difference(0.50±0.52,0.74±0.69,1.19±0.82)on plasma LDL-C among the three group before and after one month treatment had the statistically significance(P<0.01).The descend range of the high-dose group was higher than low-dose group and middle-dose group,and had the statistically significant difference(P<0.05).The descend range compared between low-dose group and middle-dose group has no statistically difference(P>0.05).The plasma LDL-C of there groups(low-dose group,middle-dose group,high-dose group)after the three months treatment was lower than the index before treatment(2.85±0.62,3.01±0.55,3.20±0.75 VS 1.99±0.42,1.65±0.39,1.58±0.37),and there was statistically significance difference(P<0.01).The comparison of the difference(0.86±0.72,1.36±0.59,1.61±0.85)on plasma LDL-C among the three groups before and after three months treatment had the statistically significance(P<0.01).The descend range of the low-dose group was lower than high-dose group and middle-dose group,and had the statistically significant difference(P<0.05).The descend range compared between high-dose group and middle-dose group has no statistically difference(P>0.05).4 Comparison of the target rates of the plasma LDL-C before and after treatment: the target rates of plasma LDL-C of there groups(low-dose group,middle-dose group,high-dose group)after the one month treatment were 30(13.3%)VS 30(20.0%)VS 28(42.9%).The target rates of plasma LDL-C of there groups(low-dose group,middle-dose group,high-dose group)after the three months treatment were 30(46.7%)VS 30(67.0%)VS 28(71.4%).5 The safety assessment of the difference doses among three groups after the treatment: There was no statistically significance difference between before and one month treatment on ALT level among the patients of three groups;there was the statistically difference between before and one month treatment on CK level among the patients of three groups.There was nostatistically significance difference between before and three months treatment on ALT level among the patients of three groups;there was the statistically difference between before and three months treatment on CK level among the patients of three groups.No case of adverse events was observed in low-dose group.Only one patient from middle-dose group complained of myalgia,but no abnormal on CK.Two of the patients from the high-dose group had the gastrointestinal discomfort and liver enzymes elevation >3 times of ULN,the symptoms disappeared 1-2 weeks after discontinuation of drug and the liver enzymes to normal;One case on myalgia,but the CK was normal.Conclusions:1 The serum HbA1 c of acute coronary syndrome patients after three months treatment by atorvastatin increased,with a dose related trend.2 In patients with acute coronary syndrome,treatment under different dose of atorvastatin can decrease low-density lipoprotein cholesterol obviously.With the increase of the dose,low density lipoprotein cholesterol drops more and faster,and the target rates of the plasma LDL-C are slightly higher.3 In patients with acute coronary syndrome high-dose(80 mg)of atorvastatin has a poor safety,so the 80 mg dose of atorvastatin needs to be careful to use;The security is higher under 20 mg or 40 mg dose of atorvastatin,so the dose of 20 mg or 40 mg is recommended,especially for40 mg. |
PDF Full Text Request