强化降脂对冠心病血管内皮功能及颈动脉内膜中层厚度的影响

Effect of Intensive Lipid lowing by Atorvastatin on Vascular Endothelial Function and Carotid Arterial Intima-media Thickness in Patients with Coronary Heart Disease

目的:观察强化降脂对冠心病患者血管内皮功能和颈动脉内膜中层厚度(CIMT)的影响。方法:随机将148例冠心病病人分为阿托伐他汀10mg·d^(-1)组72例及强化降脂40mg·d^(-1)组76例,分别于用药前及用药6个月后采空腹静脉血,测定总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C),高密度脂蛋白胆固醇(HDL-C)、甘油三酯(TG)。观察CIMT及血流介导内皮依赖性舒张功能(FMD)的变化。结果:强化降脂组,CIMT由用药前1.52±0.19mm,降至用药6个月时的1.42±0.20mm(P<0.05),较常规剂量组(1.52±0.19mm与1.51±0.19mm)有更显著的效果。两组FMD升高,TC、LDL-C水平降低(P<0.05),40mg组比10mg组更明显。结论:强化降脂治疗能更有效地降低TC和LDL-C水平,改善内皮功能,降低冠心病患者CIMT,并具有良好的安全性。

ABSTRACT Objective ： To investigate the effect of intensive lipid lowing on vascular endothelial function and carotid arterial intimamedia thickness（CIMT） in patients with c, oronary heart disease. Method： One hundred and forty-eight patients with coronary artery diseases were randomly assigned to atorvastatin 10 rag- d- 1 group （72 patients） and 40 mg·d^-1 group （ intensive lipid lowing group, 76 patients）. Changes in serum total cholesterol（TC）, low density lipoprotein cholesterol （LDL-C）, triglyceride （TG） at fast were determined, CIMT and endothelial-dependent flow-mediated vasodilation （FMD） before and after treatment were investigated. Result： The CIMT in intensive lipid lowing group （from 1.52 ± 0.19 mm before treatment to 1.42 ± 0.20 mm after six months,P 〈 0.05 ） was decreased more than 10 m·d ^-1 group（ 1.52 ± 0.19 mm vs 1.51 ± 0.19 mm,respectively）. The levels of TC, and LDL-C（P 〈0.05） in all patients were decreased and FMD was increased （ P 〈 0.05 ） after treatment. Furthermore, the changes in group of 40 mg·d^- 1 was more obviously than in group of 10 mg·d-1. Conclusion： Intensive treatment by atorvastatin more obviously decrease TC and LDL-C and improve the vascular endothelial function, prevented the increase of carotid arteriosclerosis in patients with coronary heart disease company with good safety.