小剂量阿托伐他汀对老年冠心病患者血脂、超敏C反应蛋白和颈动脉斑块的影响  

Effects of low-dose atorvastatin on blood lipids, high-sensitivity C-reactive protein and carotid plaque in elderly patients with coronary heart disease

作　　者：陈金良 邹子扬[2] 宋婷婷 李东华 刘征 刘武岩 Chen Jinliang;Zou Ziyang;Song Tingting;Li Donghua;Liu Zheng;Liu Wuyan(Department of Cardiology,Chinese PLA 281 Hospital,Qinhuangdao 066100,China)

机构地区：[1]河北省秦皇岛解放军281医院心内科,秦皇岛066100 [2]河北省唐山市解放军255医院心内科,唐山065100

出　　处：《中国循证心血管医学杂志》2018年第12期1557-1559,1564,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的观察小剂量阿托伐他汀对老年冠状动脉粥样硬化性心脏病(冠心病)患者血脂、超敏C反应蛋白和颈动脉粥样硬化斑块的影响。方法选取2016年1月～2017年12月于解放军281医院诊断为老年稳定性冠心病合并颈动脉斑块的退休军人患者182例为研究对象,随机分为小剂量组(n=64)、中剂量组(n=60)和大剂量组(n=58)来给予阿托伐他汀钙治疗,三组阿托伐他汀钙片剂量分别为5mg、10 mg、20 mg,每晚1次口服,疗程均为6个月。检测治疗前后患者血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和超敏C反应蛋白(hsCRP)水平;应用彩色多普勒超声测定颈动脉斑块大小和颈动脉内-中膜厚度(IMT)。结果三组患者治疗后血脂及hs-CRP水平较治疗前均有显著下降,差异均有统计学意义(P<0.05)。治疗后,中剂量组和大剂量组TC和LDL-C水平均明显低于小剂量组,且大剂量组低于中剂量组,差异均具有统计学意义(P均<0.05);三组患者治疗后颈动脉粥样硬化斑块直径、厚度、面积较治疗前均明显缩小(P均<0.05), IMT值亦明显降低(P均<0.05)。中剂量组和大剂量组斑块各项指标改善情况明显优于小剂量组(P均<0.05),但两组间相比,治疗后各项指标差异无统计学意义(P>0.05)。结论阿托伐他汀的调脂作用及对颈动脉斑块的疗效有剂量相关性,小剂量阿托伐他汀即能有效降低老年冠心病患者的血脂和炎性因子水平,缩小斑块面积,并且药物治疗安全性也相对较高。Objective To observe the effects of low-dose atorvastatin on blood lipids,hypersensitive C-reactive protein and carotid atherosclerotic plaque in elderly patients with coronary heart disease.Methods 182 patients with stable coronary heart disease and carotid plaque diagnosed in the 281 Hospital of Chinese People's Liberation Army from January 2016 to December 2017 were randomly divided into low-dose group(n=64)and medium-dose group(n=60)and high dose group(n=58).The doses of oral atorvastatin calcium tablets in the three groups were 5 mg,10 mg,and 20 mg,respectively,once a night for 6 months.Serum total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)and high-sensitivity C-reactive protein(hs-CRP)were measured before and after treatment.Carotid plaque size and carotid intima-media thickness(IMT)were measured by color Doppler ultrasound.Results The levels of serum lipids and hs-CRP in the three groups were significantly lower than those before treatment(P<0.05).After treatment,the levels of TC and LDL-C in the middle dose group and the high dose group were significantly lower than those in the low dose group,and the high dose group was lower than the middle dose group,the difference was statistically significant(P<0.05).The diameter,thickness and area of carotid atherosclerotic plaques in the three groups were significantly smaller than those before treatment(P<0.05),and the IMT values were also significantly decreased(P<0.05).The improvement of plaque indexes in the middle dose group and the high dose group was significantly better than that in the low dose group(P<0.05),but there was no significant difference between the two groups(P>0.05).Conclusion The lipid-lowering effect of atorvastatin and its effect on carotid plaque are dose-related.Low-dose atorvastatin can effectively reduce blood lipid and inflammatory factor levels,reduce plaque area,and drugs in elderly patients with coronary heart disease.The safety of treatment is also relative

关 键 词：阿托伐他汀钙 冠心病 老年 血脂 颈动脉粥样硬化斑块 

分 类 号：R541.4[医药卫生—心血管疾病]