Statins and C-reactive protein
Statins and C-reactive protein
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他汀类药物和 C 反应蛋白
DOI：
10.1016/s0140-6736(05)75195-3
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发表时间：
1999
期刊：
影响因子：
--
通讯作者：
K. Shimada
中科院分区：
文献类型：
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作者：
U. Ikeda;Takayuki Ito;K. Shimada
SIR-Timo Strandberg及其同事(1月9日，第118页)1显示，在大多数情况下，稳定性冠状动脉疾病的高脂血症患者服用阿托伐他汀或辛伐他汀4个月后，血清C反应蛋白(CRP)浓度下降。由于C反应蛋白受季节性波动的影响，2存在这种波动可能解释这项非对照研究结果的风险。我们对他汀类药物在不同组中的作用进行了研究。首先，我们对30名患者进行了一项随机研究，用辛伐他汀(每天20毫克)与阿昔莫司(每天3次250毫克)对照27名患者(平均年龄61岁；30名男性，27名女性)，为期3个月。我们用一种灵敏的内部方法测定C反应蛋白。3两组治疗开始时C反应蛋白水平相似，治疗1个月后无明显变化。治疗3个月后，辛伐他汀组C反应蛋白水平明显下降(中位数变化J0·34 mg/L[四分位数范围1·21]；P=0·013)，而阿昔莫司组无明显变化(J0·0 6 mg/L[3·61])；辛伐他汀组C反应蛋白下降23例，上升7例；阿昔莫司组C反应蛋白升高14例，下降13例，但两组变化无显著差异。CRP的变化与治疗后总胆固醇、甘油三酯和高密度脂蛋白-胆固醇的变化无关。这一发现证实了他汀类药物的短期疗效，不仅适用于C反应蛋白中度升高的高脂血症患者(中位数1.55 mg/L)，2也适用于已知有C反应蛋白升高的高脂血症性II型糖尿病患者(中位数3.16 mg/L[7.19])，4比较设计反对季节性影响。第二，我们对低C反应蛋白组他汀类药物对C反应蛋白的影响进行了两项研究。在一项对20名家族性高胆固醇血症患者进行的安慰剂对照研究中，治疗组每天服用40毫克普伐他汀，持续9个月，我们发现C反应蛋白与基线水平没有变化。5在一项研究中，45例家族性高胆固醇血症患者(平均年龄45岁；男性21例，女性24例)接受辛伐他汀(每天20 mg)治疗1年，基线C反应蛋白浓度中位数为1.21 mg/L[2.47]，治疗1年后C反应蛋白浓度无明显下降。
Sir—Timo Strandberg and colleagues (Jan 9, p 118) 1 show that serum C-reactive protein (CRP) concentrations decrease in most cases after treatment with atorvastatin or simvastatin for 4 months in hyperlipidaemic patients with stable coronary artery disease. Since CRP is subject to seasonal fluctuations, 2 there is a risk that such fluctuations may account for the results of this non-controlled study. We undertook studies on the effects of statins in different groups. First, we carried out a randomised study of simvastatin (20 mg daily) in 30 patients, versus acipimox (250 mg thrice daily) in 27 patients for 3 months, in hyperlipidaemic type II diabetic patients (mean age 61 years; 30 men, 27 women). We measured CRP with a sensitive in-house method. 3 CRP concentrations at the start of treatment were similar in the two treatment groups and no significant changes were seen after 1· 5 months. After 3 months of treatment, CRP concentrations were significantly reduced in the simvastatin group (median change J0· 34 mg/L [interquartile range 1· 21]; p= 0· 013), but not in the acipimox group (J0· 0 6 mg/L [3· 61]); in the simvastatin group, CRP concentrations fell in 23 patients and rose in seven patients; in the acipimox group, CRP increased in 14 and decreased in 13. However, the difference in change between the two groups was not significant. The change in CRP did not correlate with changes in total cholesterol, triglyceride, and HDL-cholesterol as a result of treatment. This finding confirms the short-term effect of statins not only for hyperlipidaemic patients with moderately raised CRP (median 1· 55 mg/L), 2 but also for hyperlipidaemic type II diabetic patients known to have raised CRP (median 3· 16 mg/L [7· 1 9]), 4 and the comparative design argues against seasonal effects. Second, we carried out two studies on the effect of statins on CRP in groups with lower CRP. In a placebocontrolled study in 20 patients with familial hypercholesterolaemia, in which the treatment group received 40 mg pravastatin daily for 9 months, we found no change in CRP from baseline. 5In a study in 45 patients with familial hypercholesterolaemia (mean age 45 years; 21 men, 24 women) who received simvastatin (20 mg daily) for 1 year, median baseline CRP concentrations were 1· 21 mg/L [2· 47], and CRP concentrations were nonsignificantly reduced after 1 year of