阿托伐他汀改善高血压合并2型糖尿病患者颈动脉粥样硬化

The Effect of Atorvastatin on Carotid Atherosclerosis Plaque in Hypertensive Patients Complicated with Type 2 Diabetes Mellitus

目的探讨阿托伐他汀对合并2型糖尿病(T2DM)的高血压(EH)患者颈动脉粥样硬化的影响及炎症在动脉粥样硬化中的作用。方法合并T2DM的高血压患者122例,入院后随机分为阿托伐他汀组(62例,A组)和常规治疗组(60例,B组)。在常规降压、降糖、抗血小板治疗的基础上,阿托伐他汀组加用阿托伐他汀10mg,每晚1次。分别于入院后及6月时测定血浆高敏C反应蛋白(hs-CRP)、脂蛋白a[LP(a)]、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C),高频超声检测颈动脉,记录颈动脉内膜-中膜厚度(IMT)、颈动脉斑块积分、斑块检出率。结果阿托伐他汀治疗后hs-CRP[(8.8±1.6)比治疗后(6.2±1.3)]mg/L、IMT[(1.24±0.13)比治疗后(0.98±0.19)]mm、颈动脉斑块积分[(6.23±0.57)比治疗后(5.07±0.42)]mm,斑块检出率(82.3%比治疗后:69.5%)显著下降,P均<0.01。相关分析表明hs-CRP下降程度与颈动脉粥样指标改善程度成正比。结论阿托伐他汀治疗可改善合并T2DM的高血压患者颈动脉粥样硬化程度及炎症反应程度,具有稳定斑块作用。

Objective To explore the effect of atorvastatin on carotid atherosclerosis in hypertensive patients complicated with type 2 diabetes mellitus. Methods One hundred twenty-two hypertensive patients complicated with type 2 diabetes mellitus were randomly to receive atorvastatin （10 mg/d, n=62） and conventional treatment group （n=60） . hs-CRP, lipoproteins（a） LP（a）, total cholesterol（TC）, and low density lipoprotein cholesterol were determined. Carotid intima-medial thickness （IMTI, incidence of carotid plaque were measured by ultrasound before and after 6 months treatment in all patients. Results hs-CRP （ 8. 8 ± 1.6 vs after treatment： 6.2 ± 1.3 mg/L）, IMT （ 1.24 ± 0.13 vs after treatment： 0.98 ± 0.19 mm）, accumulate score of carotid plaque（6.2±0. 6 vs after treatment：5.1±0. 4 mm）, the prevalence rate of carotid plaque（82.3% vs after treatment ：69.5% ） were all significantly reduced after atorvastatin treatment （ all P〈0. 01）. The correlation analysis revealed hs-CRP level was related to the improved level of carotid arteriosclerosis. Conclusion Atorvastatin improves the carotid arteriosclerosis and inflammatory reaction, promoting stabilization of atherosclerotic plaque in hypertensive patients complicated with type 2 DM.