课件：他汀类药物的不良反应及药学监护.ppt

* AST/ALT，天冬氨酸转氨酶/丙氨酸转氨酶 * * The rate of occurrence of muscular symptoms for individual statins was assessed in the PRIMO study. Patients were prescribed either pravastatin (40 mg/day), atorvastatin (40–80 mg/day), simvastatin (40–80 mg/day), or Lescol? XL (80 mg/day). The highest risk of muscular symptoms was observed among patients receiving high dosage simvastatin (18.2%). Lescol? XL was associated with the lowest numerical rate of occurrence of muscular symptoms (5.1%). Odds ratio calculations for the risk of muscular symptoms, using high dosage pravastatin as the reference, revealed that both high dosage atorvastatin and simvastatin therapy were associated with a significantly (p = 0.035 and 0.0001 respectively) higher rate of occurrence of muscular symptoms than pravastatin. In contrast, Lescol? XL treatment was associated with a significantly (p 0.0001) lower risk of muscular symptoms compared with pravastatin. The findings of the PRIMO study therefore suggest that Lescol? XL may be associated with a lower risk of muscular symptoms compared with other statins. However, it should be noted that dosages of each statin were not equivalent with regard to lipid lowering efficacy – atorvastatin 40–80 mg/day and simvastatin 40–80 mg/day lower LDL-C to a greater extent than pravastatin 40 mg/day or Lescol? XL 80 mg/day. Nevertheless, the risk of muscular adverse events with Lescol? XL was less than half that observed with pravastatin 40 mg/day, despite the fact that Lescol? XL is expected to lower LDL-C more effectively than this dose of pravastatin. * 对于他汀类治疗时血脂水平未达标的患者，美国的研究人员Grundy指出：LDL未达标的患者可以加大他汀剂量或加用烟酸或贝特类药物治疗，或者加用伊折麦布，前三种情况会增加肌病的危险性。 HDL未达标的患者可加用烟酸或贝特类药物，但两者均会增加肌病危险。 在TG未达标的患者中，可加用烟酸或贝特类药物，也可加用鱼油治疗，但前两者会增加肌病危险。 * 以前大家可能认为，各种他汀的不同只是降低LDL-C疗效的差异。通过等当量剂量换算在不同剂量的不同他汀之间可以得到一个等式。但随着一些头对头研究的出现，这一等式受到了质疑。 * 因此，根据上述研究，我们可以得到如下启示： 1. 临床实践中，即使LDL-C降低幅度相同，不同他汀的心血管获益仍有显著差异。 2. 因此，不能根据LDL-C降幅，简单的推断他汀的疗效等式。 3. 除LDL-C外，可能还有其它机制影响他汀的临床获益，如抗炎、抗氧化、改善内皮功能等机制，这些还充满未知，有待