摘要
目的探究瑞舒伐他汀和阿托伐他汀分别联合氨氯地平用于老年冠心病合并高血压患者的临床效果及安全性。方法回顾性分析2021年2月至2024年2月河北省第一荣军优抚医院收治的312例老年冠心病合并高血压患者的临床资料。根据患者接受的不同治疗方式进行分组,将接受瑞舒伐他汀联合氨氯地平治疗的患者纳入瑞舒伐他汀组(153例),将接受阿托伐他汀联合氨氯地平治疗的患者纳入阿托伐他汀组(159例)。对比两组患者的治疗有效率、血压变化(舒张压、收缩压、心率)、心绞痛发作频次、疼痛持续时间、疼痛程度[西雅图心绞痛问卷(SAQ)评分]、心功能指标(左心室射血分数、脑利钠肽、6 min步行试验)、血管内皮因子(血管内皮素1、血管内皮生长因子、一氧化氮)、炎症指标[C反应蛋白(CRP)、白细胞介素6(IL-6)、肿瘤坏死因子α(TNF-α)]及药品不良反应发生情况。结果两组患者的治疗总有效率差异无统计学意义(89.54%vs 83.02%)(P>0.05);治疗后,瑞舒伐他汀组和阿托伐他汀组的收缩压、舒张压、心率分别为[(120.37±5.62)mm Hg(1 mm Hg≈0.133 kPa)、(79.36±5.12)mm Hg、(85.46±8.51)次·min^(-1)]和[(125.41±6.03)mm Hg、(80.63±6.27)mm Hg、(84.33±8.01)次·min^(-1)],差异无统计学意义(P>0.05);瑞舒伐他汀组患者心绞痛发作频次、持续时间[(1.02±0.27)次·d^(-1)、(1.39±0.26)min]均低于阿托伐他汀组[(1.58±0.26)次·d^(-1)、(2.01±0.47)min],SAQ评分(72.14±4.14)分高于阿托伐他汀组(67.52±4.37)分(P<0.05);瑞舒伐他汀组的左心室射血分数、6 min步行试验水平[(52.06±5.76)%、(546.83±22.74)m]高于阿托伐他汀组[(48.34±6.37)%、(512.39±25.84)m],脑利钠肽(142.33±28.49)pg·mL^(-1)低于阿托伐他汀组(167.86±31.26)pg·mL^(-1)(P<0.05);瑞舒伐他汀组患者的血管内皮素1(53.17±6.42)ng·mL^(-1)低于阿托伐他汀组(62.33±5.58)ng·mL^(-1),血管内皮生长因子、一氧化氮[(78.26±6.67)pg·mL^(-1)、(73.18±5.74)μmol·L^(-1)]高于阿托伐他汀组[(69.78±5.35)pg·mL^(-1)、(65.67±5.45)μmol·L^(-1)](P<0.05);瑞舒伐他汀组患者的CRP、IL-6、TNF-α[(11.62±2.31)mg·L^(-1)、(12.24±4.97)pg·mL^(-1)、(34.51±5.29)pg·mL^(-1)]水平均低于阿托伐他汀组[(15.77±3.04)mg·L^(-1)、(15.73±4.16)pg·mL^(-1)、(44.58±6.88)pg·mL^(-1)](P<0.05);瑞舒伐他汀组和阿托伐他汀组的药品不良反应发生率(9.15%vs 10.06%),差异无统计学意义(P>0.05)。结论瑞舒伐他汀和阿托伐他汀分别联合氨氯地平对于老年冠心病合并高血压患者的疗效相当,均能有效降低患者血压水平,且瑞舒伐他汀能更好地缓解心绞痛症状,改善心功能和血管内皮功能,不会增加治疗风险。
Objective To compare the clinical effect and safety between rosuvastatin and atorvastatin respectively combined with amlodipine in elderly patients with coronary heart disease and hypertension.Methods A retrospective analysis was performed on the clinical data of 312 elderly patients with coronary heart disease and hypertension in Hebei First Rongjun Youfu Hospital between February 2021 and February 2024.According to different treatment methods,these patients were divided into rosuvastatin group(n=153,rosuvastatin+amlodipine)and atorvastatin group(n=159,atorvastatin+amlodipine).The effective rate of treatment,changes of blood pressure(diastolic blood pressure,systolic blood pressure,heart rate(HR)),onset frequency of angina,pain duration,pain degree(Seattle angina questionnaire(SAQ)),cardiac function indexes(left ventricular ejection fraction,brain natriuretic peptide,6 min walking test),vascular endothelial factors(endothelin-1,vascular endothelial growth factor,nitric oxide),inflammatory indicators(C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factorα(TNF-α))and the occurrence of adverse drug reactions were compared between the two groups.Results There was no statistically significant difference in effective rate of treatment between the two groups(89.54%vs 83.02%,P>0.05).After treatment,there was no statistically significant difference in systolic blood pressure,diastolic blood pressure or HR between the rosuvastatin group and atorvastatin group((120.37±5.62)mm Hg(1 mm Hg≈0.133 kPa),(79.36±5.12)mm Hg,(85.46±8.51)times·min^(-1) vs(125.41±6.03)mm Hg,(80.63±6.27)mm Hg,(84.33±8.01)times·min^(-1),P>0.05).The onset frequency and duration of angina in the rosuvastatin group were(1.02±0.27)times·d^(-1) and(1.39±0.26)min,lower than those in the atorvastatin group((1.58±0.26)times·d^(-1),(2.01±0.47)min),and SAQ score was higher than that in the atorvastatin group((72.14±4.14)points vs(67.52±4.37)points,P<0.05).The left ventricular ejection fraction and 6 min walking test in the rosuvastatin group were(52.06±5.76)%and(546.83±22.74)m,higher than those in the atorvastatin group((48.34±6.37)%,(512.39±25.84)m),while brain natriuretic peptide was lower than that in the atorvastatin group((142.33±28.49)pg·mL^(-1) vs(167.86±31.26)pg·mL^(-1),P<0.05).Endothelin-1 in the rosuvastatin group was lower than that in the atorvastatin group((53.17±6.42)ng·mL^(-1) vs(62.33±5.58)ng·mL^(-1)),while vascular endothelial growth factor and nitric oxide were higher than those in the atorvastatin group((78.26±6.67)pg·mL^(-1),(73.18±5.74)μmol·L^(-1) vs(69.78±5.35)pg·mL^(-1),(65.67±5.45)μmol·L^(-1),P<0.05).The levels of CRP,IL-6,TNF-αin the rosuvastatin group were(11.62±2.31)mg·L^(-1),(12.24±4.97)pg·mL^(-1) and(34.51±5.29)pg·mL^(-1),lower than those in the atorvastatin group((15.77±3.04)mg·L^(-1),(15.73±4.16)pg·mL^(-1),(44.58±6.88)pg·mL^(-1),P<0.05).There was no significant difference in incidence of adverse drug reactions between the rosuvastatin group and atorvastatin group(9.15%vs 10.06%,P>0.05).Conclusion Curative effect of rosuvastatin+amlodipine and atorvastatin+amlodipine is comparable in elderly patients with coronary heart disease and hypertension.Both combinations both can effectively reduce blood pressure.Rosuvastatin can better relieve angina symptoms,improve cardiac function and vascular endothelial function,and not increase treatment risk.
作者
赵彦彦
贾健
范佩
李晓燕
Zhao Yanyan;Jia Jian;Fan Pei;Li Xiaoyan(Department of Pharmacy,Hebei First Rongjun Youfu Hospital,Xingtai 054000,China;Department of Geriatrics,Hebei First Rongjun Youfu Hospital,Xingtai 054000,China;Department of Pharmacy,Xingtai General Hospital of North China Medical and Health Group,Xingtai 054001,China)
出处
《中国药物应用与监测》
2025年第5期810-814,共5页
Chinese Journal of Drug Application and Monitoring
基金
邢台市重点研发计划自筹项目(2022ZC098)。
关键词
老年
冠心病合并高血压
氨氯地平
瑞舒伐他汀
阿托伐他汀
Elderly
Coronary heart disease complicated with hypertension
Amlodipine
Rosuvastatin
Atorvastatin
