降脂治疗逆转冠状动脉粥样硬化Regression of coronary atherosclerotic plaque with lipid-lowering therapy
谢向荣,陈绍良,张厚军,单守杰,刘志忠,阚静
摘要(Abstract)：
目的通过血管内超声了解氟伐他汀和阿托伐他汀降脂治疗对冠状动脉粥样斑块退缩及其成分的影响。方法经冠状动脉造影(CAG)证实至少有一支主要冠状动脉存在20%～50%狭窄(目测)的70名患者,利用Excel表格按1∶1比例随机分为阿托伐他汀(20mg/d,35例)组和氟伐他汀(80mg/d,35例)组。通过血管内超声灰阶成像(C-IVUS)和虚拟组织学成像(VH-IVUS)脱机分析软件分别测量降脂治疗12个月前后冠状动脉粥样硬化斑块、血管、管腔体积及成分的变化。结果 56例(80%)患者完成全部随访过程,阿托伐他汀组及氟伐他汀组各28例。经过12个月的降脂治疗,阿托伐他汀组低密度脂蛋白胆固醇(LDL-C)由(3.43±0.65)mmol/L降至(2.11±0.41)mmol/L(P<0.001),下降(36.9±14.7)%;氟伐他汀组LDL-C由(3.36±0.69)mmol/L降至(2.75±0.85)mmol/L(P=0.002),下降(16.1±30.3)%,两组间LDL-C下降幅度差异有统计学意义(P=0.002)。阿托伐他汀组斑块体积由(351.0±152.2)mm3减至(314.4±112.9)mm3(P=0.001),下降(8.5±12.9)%;氟伐他汀组斑块体积由(294.6±87.6)mm3增至(308.4±91.5)mm3(P=0.001),增加(4.7±9.2)%,组间斑块体积变化的百分比差异有统计学意义(P<0.001)。阿托伐他汀组斑块体积下降百分比与LDL-C下降百分比呈正相关(r=0.586,P=0.001)。坏死核心(NC)比例阿托伐他汀组由(13.8±3.9)%下降至(10.8±6.9)%(P=0.023),而氟伐他汀组由(12.7±3.4)%增至(15.0±7.8)%(P=0.111),组间NC比例变化差异有统计学意义(P=0.006)。结论阿托伐他汀20mg降脂治疗可显著缩小冠状动脉粥样斑块体积,并可减少斑块坏死核心比例,斑块体积下降百分比与LDL-C下降百分比呈正相关,而氟伐他汀80mg不能阻止冠状动脉粥样硬化进展。
关键词(KeyWords)： 降血脂药;冠状动脉疾病;超声检查,介入性
基金项目(Foundation):
作者(Author): 谢向荣,陈绍良,张厚军,单守杰,刘志忠,阚静
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