CT检测他汀类药物干预冠状动脉粥样硬化斑块进展的临床研究  

Effects of statin intervention on mild coronary plaque progression assessed by serial coronary CT angiography

作　　者：李震南[1] 侯志辉[1] 刘坤[1] 王志强[1] 尹卫华[1] 高扬[1] 许海燕[2] 蒋世良[1] 吕滨[1] 

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院放射影像科,100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院心内科,100037

出　　处：《中华心血管病杂志》2016年第6期508-512,共5页Chinese Journal of Cardiology

基　　金：首都卫生发展科研专项项目（2011-4003-01）

摘　　要：目的用无创CT冠状动脉造影检测他汀类药物干预冠状动脉粥样硬化斑块的进展。方法前瞻性人选2012年9月至2013年12月期间初次CT结果为单支非梗阻性（狭窄≤50％）非钙化为主斑块病变的患者共120例，收集临床基线资料并进行随访。根据患者治疗情况分为对照组36例（未接受他汀类药物治疗）、他汀治疗低密度脂蛋白胆固醇（LDL—C）下降〈50％组43例、他汀治疗LDL—C下降〉150％组41例。测量基线和随访的斑块总体积、斑块体积百分比等指标。结果120例患者平均年龄（58．9±8．1）岁，男性74例（61．7％），随访时间705（467，803）d。随访时对照组斑块总体积[（97．3±57．8）mm^3比（82．2±57．7）mm^3]和LDL—C下降〈50％组斑块总体积[（78．5±45．2）mm^3比（77．6±50．5）mm^3]与其基线值比较差异均无统计学意义（P均〉0．05），而LDL—C下降≥50％组斑块总体积低于基线值[（61．5±46．1）mm^3比（77．7±48．1）mm^3，P〈0．05]。对照组斑块体积百分比高于基线值[（51．9±16．5）％比（45．9±12．8）％，P〈0．05]，LDL—C下降〈50％组斑块体积百分比与基线比较差异无统计学意义[（49．1±13．7）％比（47．5±14．9）％，P〉0．05]，而LDL—C下降〉150％组斑块体积百分比低于基线值[（39．1±17．1）％比（48．2±15．0）％，P〈0．01]。多元线性回归分析显示，基线斑块总体积（p=-0．50，P〈0．001）和他汀治疗LDL—C下降≥50％（p=-0．32，P=0．001）是斑块体积变化的独立相关因素。结论经CT检测发现，他汀治疗后LDL—C下降≥50％可延缓和逆转非梗阻性粥样硬化斑块的进展，斑块负荷相对较大的患者更容易从他汀治疗中获益。Objective To assess the effects of statin treatment on mild coronary plaque progression by serial coronary CT angiography. Methods A total of 120 consecutive patients （74 men, ages （58.9 ± 8.1 ）years） with mild （ ≤50% luminal narrowing and lesion length 〈 20 mm） non-calcified plaque detected by coronary CT angiography during September 2012 and December 2013 were prospectively enrolled in this study. Subjects were divided into three groups：no stafin （n = 36）, statin lowering LDL-C 〈 50% （n = 43 ）, and statin lowering LDL-C ≥50% （ n = 41 ）. Serial scans were performed after a median interval of 705 （ interquartile range ： 467,803 ） days. Total plaque volume, percent plaque volume for both baseline and follow-up were measured. Baseline and follow-up data were compared. Results Compared with baseline, total plaque volume in no statin group showed increasing trend by the end of follow-up （ （97.3 ± 57.8） mm3 vs. （ 82.2 ± 57.7 ） mm3 , P = 0. 075 ）. However, no significant change was observed as for total plaque volume （（78.5 ±45.2） mm3 vs. （77.6 ±50.5） mm3,P =0.910） in the statin lowering LDL-C 〈50% group. Total plaque volume was significantly reduced by the end of follow-up （ （ 61.5 ± 46. 1 ） mm3 vs. （77.7 ±48. 1 ） mm3 ,P =0. 024） in the statin lowering LDL-C ≥50% group. Percent plaque volume in no statin group was significantly increased by the end of follow-up （ （51.9 ± 16. 5）% vs. （45.9 ± 12. 8）%, P = 0. 036 ）. However, no significant change was observed as for percent plaque volume （ （49.1 ± 13, 7 ）% vs. （47. 5 ± 14. 9） % ,P = 0. 554 ） in the statin lowering LDL-C 〈 50% group. Percent plaque volume was significantly reduced by the end of follow-up （ （ 39. 1 ± 17.1 ） % vs. （ 48.2 ± 15.0 ） %, P = 0. 003 ） in the statin lowering LDL-C ≥ 50% group. Multivariable linear regression analysis showed that both higher baseline total plaque volume （ β = -0. 50, P 〈 0. 001 ） and statiu low

关 键 词：冠状动脉硬化 冠状血管造影术 降血脂药 

分 类 号：R541.4[医药卫生—心血管疾病]