항고지혈증 제제가 Lipoprotein (a)에 미치는 영향

Other Titles
The effects on serum lipoprotein (a) of antihyperlipidemic agents
Authors
김기태박성제서영성김대현신동학
Department
Dept. of Family Medicine (가정의학)
Issue Date
2000
Citation
가정의학회지, Vol.21(2) : 234-243, 2000
ISSN
1225-4908
Abstract
Background : Many studies to reduce serum lipoprotein (a) are done because serum lipoprotein (a) has been known to be an independent risk factor of coronary artery disease along with age, smoking, diabetes, hypertension, and hyperlipidemia. Till now, oral estrogen/androgen therapy, niacin analogue and plasmapheresis are known therapeutic methods. This study examined the relative effects of three antihyperlipidemic agents, acipimox, lovastatin, fenofibrate. Methods : Among 70 subjects (male-19, female—51) with their serum cholesterol level of more than 240mg/dL, 56 subjects who were completed 2 months antihyperlipidemic treatment (acipimox -20, lovastatin-18, fenofibrate-18) were examined for baseline total cholesterol, HDL cholesterol, triglyceride, and lipoprotein (a) and were followed up 2 months later. Results : Mean values of each group for acipimox, lovastatin, fenofibrate were as follows: total cholesterol (268.1 ±19.08, 287.1 ±36.42, 268.9 ± 25.99), HDL cholesterol (43.5 ±10.99, 42.7 ±11.88, 37.9 ±8.20), triglyceride (226.1 ±165.03, 260.4± 175.98, 234.3±124.33), LDL cholesterol (179.3±30.40, 192.3 ±41.52, 184.1 ±38.08), lipoprotein (a) (26.2 ±15.32,34.8 ±18.56,29.9 ±12.58). Mean percentile reduction of lipoprotein (a) was acipimox-41.4% (P <0.0001), lovastatin - 22.2% (P< 0.0001), fenofibrate —16.1 % (P < 0.05), and p value was less than 0.05 in the comparison of groups. Lipoprotein (a) showed no relations with age, sex, BMI, WHR, smoking, total cholesterol, HDL cholesterol, triglyceride and LDL cholesterol. After 2 months treatment, mean reduction percentages of total cholesterol was acipimox-12.2% (P<0.0001), lovastatin-17.6%(P<0.0001), fenofibrate-8.85%(P< 0.05). LDL cholesterol was acipimox-16.12% (P<0.0001), lovastatin - 22.89% (P< 0.0001), fenofibrate-12.06% (P<0.05). Triglyceride was acipimox-17.24%(P<0.0001), lovastatin-17.39% (p<0. 0001), fenofibrate-9,78% (P<0.05). HDL cholesterol was elevated in acipimox-17.24% (P<0.05), lovastatin-16.10% (P<0.05) and fenofibrate-12.06(P<0.05). In total cholesterol(P<0.05) and LDL cholesterol (P< 0.05), there were significant differences among 3 groups, but not in HDLcho-lesterol and triglycerides. Conclusion : In two months treatment of acipimox, lovastatin and fenofibrate in hyperlipidemic patients, lipoprotein (a), known for independent risk factor of coronary artery disease, was reduced significantly in the order of acipimox, lovastatin and fenofibrate. (J Korean Acad Fam Med 2000; 21 :234-243) Keywords : hyperlipidemia, lipoprotein (a), acipimox, lovastatin, fenofibrate
연구배경 : 관상동맥질환의 위험인자로 알려진 나이,흡연,당뇨,고혈압, 고지혈중과 함께 lipoprotein (a)가 중요단독위험인자로 대두됨에 따라 lipoprotein (a)를 감소시키는 연구가 활발히 진행중이다. 현재까 지는 oral estrogen/androgen요법,niacin제제,혈장 반출법이 치료법으로 알려져 있다. 본 연구에서는 항 고지혈증 제제인 acipimox, lovastatin, fenofibrate가 lipoprotein (a)에 대한 효과를 비교해 보고자 하였다. 방법 : 1997년 6월 한달동안 대도시 대학병원 건강중진센터를 방문한대상자 가운데 혈중 total cholesterol이 240mg/dL이상인 70명(남자 19명, 여자51명)중2개월간의 항고지혈증 치료를마친 56명(acipimox-20명, lovastatin-18명, fenofibrate-18명)을 대상으로 치료시작전에 total cholesterol, HDL-cholesterol, triglyceride, lipoprotein (a)를 검사하고 2개월후 추적 검사하였다. oneway ANOVA test를 사용하여 세 군간의 혈중지질의 변화정도를 비교했으며 각 군내에서의 혈중지질의 비교는 paired T-test를 사용했다. 결과 : 투약 전 acipimox, lovastatin, fenofibrate 세 군의 혈중지질의 평균값은 각각 total cholesterol glyceride 268.1土19.03, 287.1土36.42’ 268.9±25.99), HDL-cholesterol(43.5±10.99’, 42.7±11.88, 37.9土8.20), triglyceride(226.1土165.03,260.4土175.98, 234.3±124.33), LDL一 cholesterol(179.3±30.40, 192.3土41.52,184.1 ±38.08), lipoprotein (a) (26.2土15.32,34.8±18.56,29.9土12.58) 이었다. acipimox, lovastatin, fenofibrate를 투여한후 lipoprotein (a)의 감소정도는 각각 41.4%(p<0.0001), 22.2%(p<0.0001), 16.1%(p<0.05)로 나타났고 각 군간의 평균감소율의 비교에서는 acipimox, lovastatin, fenofibrate의 순서로 유의한 차이를 보였다 (p<0.05). 치료시작전의 lipoprotein (a)의 값은 성별, 나이, 체질량지수, 허리/엉덩이둘레비,홉연에 따라 유의한 차이를 보이지 않았으며 total cholesterol, HDL-cholesterol, triglyceride, LDL-cholesteol에도 유 의한 차이를 보이지 않았다. 2개월 치료후 total cholesterol은 acipinox: 12.20%(p<0.0001),lovastatin: 17.60%(p<0.0001), fenofibrate:8.85%(p<0.05)로 각 군내와 군간에 유의한 차이률 보였으며 (p<0.05), LDL-cholesterol에서도 acipimox: 16.12%(p<0.0001), lovastatin: 22.89%(p<0.0001), fenofibrate: 12.06%(p<0.05)로 각 군내에서 유의한 감소를 보이면서 세 군간에 유의한 차이를 보였다 (p<0.05). HDL-cholesterol은 acipimox: 17.24%(p<0.05%), lovastatin: 16.10%(p<0.05%), fenofibrate: 12.06%(p<0.05)로 증가하였고 triglyceride는 acipimox: 17.24%(p<0.0001), lovastatin: 17.39%(p<0.0001), fenofibrate:9.78%(p<0.05)로 감소하여 각군내에서는 유의한 증감을 보이나 세 군간에는 유의한 차이가 없었다. 결론 : 고지혈중 환자를 대상으로 2개월간의 acipimox, lovastatin, fenofibrate를 투여한 결과 관상동맥 질환 단독위험인자로 알려진 lipoprotein (a)는 유의한 감소를 보였으며 acipimox 제제, lovastatin제제, fenofibrate제제의 순서로 감소 정도가 많았다. (가정의학회지 2000 ; 21 : 234~249)
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/37508
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1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Family Medicine (가정의학)
Keimyung Author(s)
서영성; 김대현; 신동학
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