阿托伐他汀强化降脂对冠心病患者血管内皮功能及颈动脉内膜中层厚度的影响

Effect of intensive lipid lowering by atorvastatin on vascular endothelial function and carotid arterial intima-media thickness in patients with coronary heart disease

目的观察冠心病患者强化降脂后,血管内皮功能和颈动脉内膜中层厚度(CIMT)的变化。方法随机将148例冠心病患者分为阿托伐他汀常规剂量(10 mg/d)组72例,强化降脂(40 mg/d)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);以超声观察CIMT及肱动脉内皮依赖性舒张功能(FMD)的变化。结果强化降脂组治疗后6个月,CIMT由用药前(1.52±0.19)mm降至用药6个月时的(1.42±0.20)mm,且治疗后与常规剂量组(1.51±0.19)mm比较差异有统计学意义(均P<0.05);两组FMD升高,TC、LDL-C水平降低,治疗后6个月的强化降脂组比常规剂量组更明显(P<0.01)。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CIMT,并具有良好的安全性。

Objective To investigate the effect of intensive lipid lowering of atorvastatin on vascular endothelial function and carotid arterial intima-media thickness（CIMT） in patients with coronary heart disease（CHD）. Methods One hundred and forty-eight CHD patients were randomised to atorvastatin 10 mg/d common group（72 patients） and 40 mg/d intensive lipid lowing group（76 patients）. Changes in serum total cholesterol（TC）, low density lipoprotein cholesterol （LDL-C）, triglyceride（TG）, CIMT and brachial arterial endothelium dependent diastolic function（FMD） before and after treatment were investigated by ultrasound after six months. Results CIMT in intensive lipid lowering group was reduced from （1. 52 ± 0. 19） mm before treatment to （1. 42 ± 0.20） mm after six months of treatment, also was lower significantly than that of common group （1. 5 1 ± 0. 1 9） mm（both P 〈0. 05）. The levels of TC, and LDL-C in both groups were decreased and FMD was increased after treatment. Furthermore, the changes in group of 40 mg/d were more obvious than in group of 10 mg/d. Conclusion Intensive treatment by atorvastatin more obviously decreases TC and LDL-C and improves the vascular endothelial function, prevente the increase of carotid arteriosclerosis in patients with CHD safely.