不同剂量阿托伐他汀对稳定性斑块的影响  

The effect of different loading doses of atorvastatin in patients with stable plaques

作　　者：高长征[1] 郭素峡[2] 

机构地区：[1]江苏省无锡市第四人民医院心内科,214000 [2]南京医科大学附属无锡市人民医院心内科

出　　处：《中国综合临床》2013年第2期142-145,共4页Clinical Medicine of China

摘　　要：目的探讨不同剂量阿托伐他汀对稳定性斑块的影响。方法入选经冠状动脉造影和血管内超声检查确定为稳定性斑块的174例患者，分为4组：阿托伐他汀10mg组47例，阿托伐他汀20mg组45例，阿托伐他汀40mg组43例，阿托伐他汀80mg组39例，随访3—6个月，观察给予他汀药物的4组低密度脂蛋白胆固醇（LDL—C）、高密度脂蛋白胆固醇（HDL—C）、超敏C反应蛋白（hs—CRP）、坏死核所占百分比及斑块体积的动态变化。结果各组患者LDL—C、HDL—C、hs—CRP、坏死核所占百分比及斑块体积的基线水平是相近的（P均〉0．05）。随访3～6个月后（1）阿托伐他汀治疗的4组LDL—C与基线相比均有明显下降（t值分别为3．12、4．23、3．26、5．21，P均〈0．01），且阿托伐他汀20mg组和40mg组治疗后两组间LDL—C不同（P〈0．05）；（2）阿托伐他汀10、20、40mg组治疗后HDL—C与基线比较差异均无统计学意义，但阿托伐他汀80mg组HDL—C明显高于其余3组（P均〈0．05），同时高于基线（t=2．35，P〈0．01）；（3）阿托伐他汀80mg治疗后hs—CRP较基线显著下降[分别为（3．59±1．07）mg／L与（6．10±2．12）mg／L，t=2．37，P〈0．01]；（4）通过血管内超声虚拟组织成像技术（IVUS—VH）检测，斑块坏死核所占百分比在阿托伐他汀10mg组明显高于基线[16．54±1．76）％与（7．83±1．03）％，t=2．38，P〈0．01]，提示斑块向不稳定进展（坏死核所占百分比〉10％定义为不稳定性斑块），在阿托伐他汀20、40、80mg组与基线相比无进展（t值分别为1．24、0．21、0．69，P值分别为0．069、0．846、0．643）；（5）斑块体积在阿托伐他汀10、20mg组与基线相比无增大，但是在阿托伐他汀40、80mg组斑块体积明显缩小[（30．69±8．12）mm。与（37．09±12．01）mm^3，t=1．29，P=0．019；（24．99±1．01）mm。与（36．474-14．68）mm^3，tObjective To investigate the effect of different loading doses of atorvastatin in patients with stable plaques. Methods Consecutive 174 patients with stable plaque who underwent coronary arteriongraphy （CAG） and intravascular unltrasound （IVUS） were randomly assigned to receive 10 mg atorvastatin treatment （ group l0 mg, n = 47 ）, 20 mg atorvastatin treatment （ group 20 mg, n = 45 ） ,40 mg atorvastatin treatment （ group 40 mg, n = 43 ） and 80 mg atorvastatin treatment （ group 80 mg, n = 39 ）. The endpoints including low density lipoprotein-eholesterol （ LDL-C ）, high density lipoprotein-cholesterol （ HDL-C ） , high-sensitivity C-reactive protein （hs-CRP） levels, necrotic and plaque volumes, were assessed after 3 -6 months＇ follow-up. Results Mean LDL-C, HDL-C, hs-CRP, the percentage of necrotic, plaques volumes were similar at baseline （ P 〉 0. 05 ）. During 3 -6 months of follow up： （1）LDL-C levels in group 10 rag,20 rag,40 mg,80 mg were lower than at baseline （t = 3. 12,4. 23,3.26 and 5.21 respectively, P 〈 0. 01 ）. There was significant difference between the 20 mg group and the 40 mg group（P 〈0. 05） ; （2）There was no significant difference of HDL-C levels in 10 mg,20 mg and 40 mg groups after atorvastatin treatment. However,its level was significantly higher in the 80 mg group after atorvastatin treatment than other dose groups （ P 〈 0. 05 ） and were higher than at baseline （ t = 2. 35, P 〈 0. 01 ） ; （3） the 80 mg group＇s hs-CRP levels decreased significantly after treatment than at baseline（ （3.59 ± 1.07 ）mg/L vs （ 6. 10 ＋ 2. 12） mg/L, t = 2. 37, P 〈 0. 01 ） ; （4） According to the VH of IVUS, the percentage of necrotic in 10 mg group became higher than at baseline （ （ 16. 54 ± 1.76 ） % vs. （ 7.83 ＋ 1.03 ） %, t = 2. 38, P 〈 0. 01 ） and conformed to unstable plaques diagnostic criteria（ 〉 10% ）. There was no significant difference in group 20 mg,40 mg and 80 mg with at baseline （ t =

关 键 词：稳定性斑块 阿托伐他汀 血脂 超敏C反应蛋白 斑块体积 血管内超声虚拟组织学 

分 类 号：R54[医药卫生—心血管疾病]