急性心肌梗死患者血脂水平变化及用药情况研究

doi:10.12114/j.issn.1007-9572.2021.01.407

中国全科医学 ›› 2023, Vol. 26 ›› Issue (11): 1325-1329.DOI: 10.12114/j.issn.1007-9572.2021.01.407

所属专题：心血管最新文章合集

急性心肌梗死患者血脂水平变化及用药情况研究

刘传芬¹, 李政², 伍满燕¹, 崔淯夏¹, 宋婧¹, 张椿英¹, 陈红¹^,^*()

1．100044　北京市，北京大学人民医院心内科　急性心肌梗死早期预警和干预北京市重点实验室　心血管转化医学研究中心
2．610011　四川省成都市第二人民医院

收稿日期:2022-06-21 修回日期:2022-10-04 出版日期:2023-04-15 发布日期:2023-01-04
通讯作者: 陈红
刘传芬，李政，伍满燕，等.急性心肌梗死患者血脂水平变化及用药情况研究[J].中国全科医学，2023，26（11）：1325-1329.[www. chinagp. net]

作者贡献：刘传芬进行研究的实施与可行性分析，负责文章的质量控制及审校；陈红进行文章的构思与设计，对文章整体负责，监督管理；李政撰写论文；李政、伍满燕、崔淯夏、宋婧、张椿英进行数据收集、数据整理、统计学处理并对结果进行分析。
基金资助:
国家自然科学基金资助项目(81770356); 北京市科技计划重大项目(D14110700300000)

Analysis of Serum Lipid Level and Drug Use in Patients with Acute Myocardial Infarction

LIU Chuanfen¹, LI Zheng², WU Manyan¹, CUI Yuxia¹, SONG Jing¹, ZHANG Chunying¹, CHEN Hong¹^,^*()

1. Department of Cardiology, Peking University People's Hospital/Beijing Key Laboratory of Early Warning and Intervention for Acute Myocardial Infarction/Cardiovascular Translational Medicine Research Center, Beijing 100044, China
2. Chengdu Second People's Hospital, Chengdu 610011, China

Received:2022-06-21 Revised:2022-10-04 Published:2023-04-15 Online:2023-01-04
Contact: CHEN Hong
About author:
LIU C F, LI Z, WU M Y, et al. Analysis of serum lipid level and drug use in patients with acute myocardial infarction [J]. Chinese General Practice, 2023, 26 (11): 1325-1329.

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摘要/Abstract

摘要： 背景血脂异常与急性心肌梗死（AMI）发生密切相关，影响患者的预后，了解AMI患者的血脂变化，对临床给患者施行更好的调脂治疗有重要意义。目的探讨AMI患者在住院期间和出院后随访期间的血脂水平变化情况。方法连续入选2015-01-01至2018-02-28于北京大学人民医院心内科住院治疗的AMI患者457例，监测患者住院期间和出院随访时第一次复查时血脂水平演变情况，并记录患者服药情况。结果 AMI患者不同时间点低密度脂蛋白胆固醇（LDL-C）水平比较，差异有统计学意义（P<0.05）。发病后24 h内LDL-C呈下降趋势，发病后24 h左右的LDL-C达到（2.21±0.63）mmol/L，较入院时平均下降（0.98±0.34） mmol/L，此后患者的LDL-C水平逐渐趋于平稳。AMI患者不同时间点TC水平比较，差异有统计学意义（P<0.05）。发病后24 h内呈下降趋势，发病后24 h左右总胆固醇（TC）水平较入院时平均下降（1.34±0.46）mmol/L，此后患者的TC水平趋于平稳。AMI患者不同时间点高密度脂蛋白胆固醇（HDL-C）水平比较，差异有统计学意义（P<0.05）。发病后12 h内呈下降趋势，此后患者的HDL-C水平趋于平稳。AMI患者不同时间点三酰甘油（TG）水平比较，差异有统计学意义（P<0.05）。发病后12 h内呈上升趋势，24 h后有所下降，此后患者TG水平趋于平稳。在调脂治疗方面，36.8%（168/457）的AMI患者于院前接受调脂治疗；院前未接受调脂治疗的人群中，有28.2%（129/457）的患者在院前已患有动脉硬化性心血管疾病。院内99.2%（453/457）的患者加用调脂治疗，药物以他汀类为主，剂量以中等剂量为主。至出院后1年时，仅有59. 3%（271/457）的患者仍坚持规律服用调脂药物。出院后随访期间患者的血脂达标率为43.7%（200/457）。结论 AMI患者发病后24 h左右LDL-C下降达到谷值，院前未服用调脂药物的患者下降趋势更明显；AMI患者的调脂治疗以中等剂量他汀类药物为主，院内他汀使用率可达99.2%，但随访期间患者的LDL-C达标率为43.7%，提高患者的依从性可能对提升达标率有益。

关键词: 心肌梗死, 血脂异常, 胆固醇, 调脂治疗, 他汀类药物, 治疗结果

Abstract:

Background

Dyslipidemia is closely related to the occurrence of acute myocardial infarction (AMI) and affects the prognosis of patients. Understanding blood lipid changes in patients with AMI is of great significance for improving lipid-lowering treatments for these patients.

Objective

To explore the evolution of blood lipid levels in patients with AMI during hospitalization and post-discharge follow-up.

Methods

This study consecutively selected 457 cases of AMI who were hospitalized in Department of Cardiology, Peking University People's Hospital from January 1, 2015 to February 28, 2018. They were monitored for blood lipid levels during hospitalization and the first post-discharge follow-up. The patient's medication status was recorded.

Results

The low-density lipoprotein cholesterol (LDL-C) level in AMI patients varied statistically significantly by the measurement time point (P<0.05). Specifically, LDL-C showed a decreasing trend within 24 h after the onset of AMI, then reached (2.21±0.63) mmol/L at about 24 h after the onset, which decreased by (0.98±0.34) mmol/L on average compared with the admission level. After that, the level of LDL-C gradually stabilized. The total cholesterol (TC) level differed statistically significantly across measurement time points (P<0.05). To be specific, it decreased by an average of (1.34±0.46) mmol/L at about 24 h after the onset of the disease, and then stabilized. There were statistically significant differences in the high-density lipoprotein cholesterol (HDL-C) level of AMI patients at different time points (P<0.05). The HDL-C level of patients decreased within 12 h after onset, and then stabilized. There were statistically significant in triglyceride (TG) levels of AMI patients at different time points (P<0.05). After the onset of the disease, the TG level of the patients increased within 12 h and decreased after 24 h, and then stabilized. In terms of lipid-regulating therapy, 36.8% (168/457) of AMI patients received lipid-regulating therapy before the hospitalization. Among those who were not engaged in lipid-regulating treatment prior to hospitalization, 28.2% (129/457) had already suffered from arteriosclerotic cardiovascular disease. During the hospitalization, 99.2% (453/457) of the patients were treated with lipid-regulating therapy, mainly statins at medium doses. By one year after discharge, only 59.3% (271/457) of patients still regularly took lipid-regulating drugs. In the follow-up period after discharge, 43.7% (200/457) of patients met the standard of blood lipids.

Conclusion

At about 24 h after the onset of AMI, the LDL-C of AMI patients dropped to the bottom, and the trend of decline was more obvious in those who received no lipid-lowering drugs before hospitalization. The lipid-lowering treatment for them was mainly based on medium-dose statins, and the in-hospital statin usage rate reached 99.2%, but the rate of patients meeting the target LDL-C level during follow-up period was 43.7%, which may be enhanced by improving patient compliance.

Key words: Myocardial infarction, Dyslipidemias, Cholesterol, Lipid-lowering, Statins, Treatment outcome

刘传芬,李政,伍满燕,等. 急性心肌梗死患者血脂水平变化及用药情况研究[J]. 中国全科医学, 2023, 26(11): 1325-1329. DOI: 10.12114/j.issn.1007-9572.2021.01.407.
LIU Chuanfen,LI Zheng,WU Manyan, et al. Analysis of Serum Lipid Level and Drug Use in Patients with Acute Myocardial Infarction[J]. Chinese General Practice, 2023, 26(11): 1325-1329. DOI: 10.12114/j.issn.1007-9572.2021.01.407.

图/表 5

表1 不同时间监测AMI患者血脂水平变化（n=457，±s，mmol/L）

Table 1 The changes of serum lipid levels in AMI patients monitored at different times

时间	LDL-C	TC	HDL-C	TG
入院时	3.19±0.73	5.29±1.24	1.27±0.21	1.53±1.02
12 h	2.97±0.83^a	4.28±0.99^a	0.98±0.16^a	2.08±0.88^a
18 h	2.65±0.59^ac	4.21±0.53^a	0.96±0.22^a	1.99±0.72^a
24 h	2.21±0.63^abc	3.95±0.38^abc	1.02±0.43^a	2.13±1.16^a
D2	2.23±0.78^abc	4.18±0.93^a	0.99±0.36^a	1.89±0.53^abd
D3	2.34±0.66^abc	4.20±0.62^a	0.98±0.38^a	1.91±0.60^abd
D4	2.29±0.48^abc	4.00±0.48^abc	1.01±0.39^a	1.85±0.51^abd
D5	2.30±0.81^abc	4.17±0.56^a	0.88±0.08^ab	1.83±0.37^abd
D6	2.32±0.71^abc	4.25±0.82^a	0.92±0.15^ab	1.92±0.44^abd
D7	2.30±0.55^abc	4.28±0.46^a	0.95±0.16^a	1.82±0.28^abd
D15	2.40±0.68^abc	4.26±0.36^a	0.94±0.22^a	1.68±0.69^abd
D30	2.46±0.73^abc	4.25±0.67^a	0.91±0.26^ab	1.57±0.88^bd
F值	96.428 7	103.896 1	62.147 1	30.895 6
P值	<0.001	<0.001	<0.001	<0.001

图1 不同时间监测AMI患者LDL-C水平变化趋势注：LDL-C=低密度脂蛋白胆固醇，AMI=急性心肌梗死；D2=监测第2天，D3=监测第3天，D4=监测第4天，D5=监测第5天，D6=监测第6天，D7=监测第7天，D15=监测第15天，D30=监测第30天，D40=监测第40天

Figure 1 The trend of LDL-C level in AMI patients detected at different times

图2 不同时间监测AMI患者TC水平变化趋势注：TC=总胆固醇

Figure 2 The trend of TC level in AMI patients detected at different times

图3 不同时间监测AMI患者HDL-C水平变化趋势注：HDL-C=高密度脂蛋白胆固醇

Figure 3 The trend of HDL-C level in AMI patients detected at different times

图4 不同时间监测AMI患者TG水平变化趋势注：TG=三酰甘油

Figure 4 The trend of TG level in AMI patients detected at different times

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急性心肌梗死患者血脂水平变化及用药情况研究

Analysis of Serum Lipid Level and Drug Use in Patients with Acute Myocardial Infarction

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