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合理用药是全球永不言衰的话题,而欲做到合理用药就须从掌握同类药物的共性入手,熟悉每个药物的个性(共性、异质性),以循证、辨证和个体化给药(量身定制)。他汀类药由于具有降脂以外的药理学效应,已从单一的调节血脂药,发展成为一类重要的抗动脉粥样硬化药,而广泛用于动脉粥样硬化性心血管疾病,并已载入多国的最新临床指南。但也由此带来其单效应和多效应,脂、水溶性利弊的学术之争。阿托伐他汀水脂兼溶,水、脂溶性适中,并亲脂入膜,亲脂性增强对限速酶的亲和力,易透过血管平滑肌内膜和对肝脏的选择性,但更高的亲脂性则可完全的分布非肝脏组织和肌肉,带来肌毒性,因此高脂溶性的他汀类药存在更多的肌肉安全性问题。学术界的争议是正常的、有益的和必须的,仅此,才能推动理论的进步和学科的发展。鉴于药品的双重性和复杂性,正确地认知一个药品(包括安全、有效、经济性),需要在人类漫长的临床实践进程中体现,从己烯雌酚到沙利度胺,再从非甾体抗炎药到钙通道阻滞剂,每每都需经过深化、反复甚至颠覆,他汀类药亦是如此。
Reasonable use of drugs is the world’s never-ending topic, and to be rational use of drugs must be from the common grasp of similar drugs to start with, familiar with each drug’s personality (commonality, heterogeneity), evidence-based, dialectical and individual Medicine (tailored). Statins have developed into a class of important anti-atherosclerotic drugs from a single lipid-lowering drug due to pharmacological effects other than lipid-lowering drugs and are widely used in atherosclerotic cardiovascular diseases and have been described The latest clinical guide to many countries. But it also brings its single effect and multi-effect, lipid, water-soluble pros and cons of the academic dispute. Atorvastatin water-soluble, water, fat-soluble moderate, and lipophilic into the membrane, lipophilic enhance the affinity of the rate-limiting enzyme, easy to penetrate the vascular smooth muscle intima and the liver selectivity, but higher relatives Lipid can be completely distributed in non-liver tissue and muscle, bringing muscle toxicity, so fat-soluble statins have more muscle safety issues. Academic controversy is normal, useful and necessary, only in this can promote the progress of theory and discipline development. In view of the duality and complexity of drugs, the correct cognition of a drug (including safe, effective and economical) needs to be manifested in the long course of human clinical practice. From diethylstilbestrol to thalidomide, Inflammatory drugs to calcium channel blockers, often need to be deepened, repeated or even subversion, statins as well.