瑞舒伐他汀强化降脂治疗对冠状动脉临界病变斑块结构的影响

Effects of Rosuvastatin Intensive Lipid Lowering Therapy on Plaque Composition of Coronary Borderline Stenosis

目的探讨瑞舒伐他汀强化降脂治疗对冠状动脉临界病变斑块组分及结构的影响。方法选择冠状动脉造影(CAG)血管直径狭窄50%~70%的病例,化验低密度脂蛋白胆固醇(LDLC),并对狭窄部位进行虚拟组织学血管内超声(VH-IVUS)检查,记录斑块组分(如脂质斑块、纤维斑块、钙化斑块、混合斑块及易损斑块)及结构(斑块负荷、最小管腔面积、管腔面积狭窄率、外弹力膜面积)的变化。所有病人给予瑞舒伐他汀10~20 mg。根据LDLC水平分组,强化达标组42例(LDLC≤1.8 mmol/L),对照组41例(LDLC 1.9~2.6 mmol/L)。服用瑞舒伐他汀1年,完成试验80人,重新做CAG及VH-IVUS。结果与治疗前相比,两组病人治疗后脂质斑块成分减少,易损斑块减少,强化达标组较对照组减少更明显(P<0.05)。与治疗前相比,两组病人治疗后纤维斑块及纤维混合斑块均增多,强化达标组较对照组增多更明显(P<0.05)。与治疗前相比,两组病人治疗后斑块负荷均明显下降(45%±6%比62%±7%,P<0.05;49%±6%比61%±7%,P<0.05),强化达标组较对照组斑块负荷下降更明显(45%±6%比49%±6%,P<0.05)。两组治疗后最小管腔面积增加,强化达标组较对照组增加更明显(P<0.05)。两组治疗后血管外弹力膜面积略有减少,正重构减轻。结论瑞舒伐他汀强化治疗能减少临界病变斑块的脂质成分,稳定斑块,减轻斑块负荷。

Aim To investigate the effects of rosuvastatin intensive lipid lowering therapy on plaque composition and structure of coronary borderline stenosis. Methods The patients with vessel diameter stenosis ratio between 50%~ 70% diagnosed by coronary angiography( CAG) were studied. Low density lipoprotein cholesterol( LDLC) was tested and lesion location was evaluated by virtual histology intravascular ultrasound( VH-IVUS). Changes on plaque composition( such as lipid plaque,fibrous plaque,calcific plaque,mixed plaque and vulnerable plaque) and structure( such as plaque burden,minimal lumen area,and external elastic membrane area) were recorded. All patients with rosuvastatin10 ~ 20 mg daily were assigned into intensive standard group( LDLC≤1. 8 mmol / L) of 42 cases and control group( LDLC1. 9 ~ 2. 6 mmol / L) of 41 cases. Keeping on taking rosuvastatin for one year,80 patients completed the trial and repeated CAG and VH-IVUS assay at last. Results Compared with pre-treatment,lipid plaque content and vulnerable plaque decreased( P < 0. 05) after rosuvastatin therapy,while fibrous plaque and mixed plaque increased( P < 0. 05).In addition,changes in intensive standard group were more obvious than the ones in control group( P < 0. 05). As for plaque burden,it decreased after therapy in two groups( 45% ± 6% vs 62% ± 7%,P < 0. 05; 49% ± 6% vs 61% ± 7%,P < 0. 05),while the decrease in intensive standard group was more significant than that in control group( 45% ± 6% vs49% ± 6%,P < 0. 05). Minimal lumen area increased more in the intensive standard group than the control group. After therapy external elastic membrane area showed a slight decrease and positive remodeling alleviated. Conclusion Rosuvastatin intensive therapy could reduce lipid content in intermediate lesions,stabilize plaques and decrease plaque burden.