血管内超声评价他汀类药物治疗不稳定型心绞痛前后冠状动脉斑块稳定性的观察  

Stability of coronary plaques before and after statin therapy evaluated by intravascular ultrasound in patients with unstable angina

作　　者：薛强[1] 曹雯丽 饶莉[1] 杨静[1] 张巧月 付乐 肖辉[3] 任彩丽[1] 邢静 XUE Qiang;CAO Wenli;RAO Li;YANG Jing;ZHANG Qiaoyue;FU Le;XIAO Hui;REN Caili;XING Jing(Tangshan Workers’Hospital,Tangshan,Hebei,063000,China;People’s Liberation Army 95795 Force Health Team;Tangnan Fengnan District Hospital)

机构地区：[1]唐山市工人医院,河北唐山063000 [2]中国人民解放军95795部队卫生队 [3]唐山市丰南区医院

出　　处：《临床心血管病杂志》2020年第5期438-444,共7页Journal of Clinical Cardiology

摘　　要：目的:探究血管内超声(IVUS)评价他汀类药物治疗冠心病不稳定型心绞痛前后冠状动脉(冠脉)斑块稳定性的价值。方法:选取2017年5月-2019年3月于本院就诊的214例冠心病不稳定型心绞痛患者作为研究对象。依据冠脉狭窄程度,将患者分为50%~70%狭窄组和>70%狭窄组。50%~70%狭窄组进一步进行IVUS检查提示存在破裂斑块,随机分成强化他汀组和常规他汀组;>70%冠脉狭窄组进一步行经皮动脉介入(PCI)治疗,同样随机分为强化他汀组和常规他汀组。比较各组治疗前及治疗后3、6及9个月的血脂水平、血管体积、管腔体积、斑块体积变化。结果:与治疗前相比,强化他汀组与常规他汀组治疗后3、6、9个月血清高敏C反应蛋白(hs-CRP)、氧化型低密度脂蛋白(ox-LDL)、肌酸激酶同工酶(CK-MB)、心肌肌钙蛋白I(cTnI)、血小板活化因子(PAF)及白细胞介素因子6(IL-6)的表达均显著降低,且强化他汀组较常规他汀组降低更显著(均P<0.05)。50%~70%狭窄组和>70%狭窄组中,强化他汀组心血管事件发生率均显著低于常规他汀组(均P<0.05);强化他汀组治疗后6、9个月时血管体积均明显低于常规他汀组(均P<0.05);强化他汀组与常规他汀组不良反应发生率差异显著(P<0.05)。结论:强化他汀类药物可显著改善血脂水平,降低心血管事件的发生率,对治疗冠心病不稳定型心绞痛具有一定的临床意义;IVUS检测能有效评价他汀类药物对冠脉斑块稳定性的作用,值得临床推广。Objective:To observe of the stability of coronary plaques before and after statin therapy evaluated by intravascular ultrasound in patients with unstable angina.Method:A total of 214 patients with unstable angina pectoris who were treated in our hospital from May 2017 to March 2019 were selected.According to the degree of coronary artery stenosis,all patients were divided into 50%-70%stenosis group and>70%stenosis group.Further IVUS examination in the 50%-70%stenosis group suggested the presence of ruptured plaque,which were randomly divided into the enhanced statin group and the conventional statin group.Patients in the>70%stenosis group were treated with percutaneous coronary intervention(PCI),and also randomly divided into the enhanced statin group and the conventional statin group.Changes in blood lipid levels,blood vessel volume,lumen volume,and plaque volume were compared before and 3,6,and 9 months after treatment.Result:Serum levels of high sensitive C-reactive protein(hs-CRP),oxidized low density lipoprotein(ox-LDL),creatine kinase isoenzyme(CK-MB),cardiac troponin I(cTnI),platelet activating factor(PAF),and interleukin-6(IL-6)3,6,9 months after treatment in the enhanced and conventional statin group were significantly reduced,and the decrease in the enhanced statin grupp was more significant(all P<0.05).Both in 50%-70%and>70%stenosis group,the incidence of cardiovascular events in the enhanced statin group was significantly lower than that in the conventional statin group(both P<0.05);the volume of blood vessels 6 and 9 months after treatment in the enhanced statin group was significantly lower than that in the conventional statin group(all P<0.05);the adverse reactions between the two groups were statistically significant(P<0.05).Conclusion:Strengthening statins can significantly improve the blood lipid,reduce theincidence of cardiovascular events,and have certain clinical significance for the treatment of unstable angina pectoris.IVUS can effectively evaluate the stability of coronary plaques treated

关 键 词：冠心病 不稳定型心绞痛 血管内超声 冠状动脉造影 冠状动脉斑块 

分 类 号：R541.4[医药卫生—心血管疾病]