老年下肢动脉硬化患者调脂治疗的临床研究

Clinical study on lipid-lowering therapy with simvastatin in elderly patients with lower extremity atherosclerosis disease

目的观察降脂药物辛伐他汀对老年下肢动脉硬化患者的作用。方法回顾性分析343例老年下肢动脉硬化患者的临床资料，均经B超和（或）数字减影血管造影证实，选择其中128例资料完整的病例为研究对象。其中64为伴有间歇性跛行的下肢动脉硬化患者，且接受降脂治疗（治疗组），64例为无临床症状下肢动脉硬化患者（无症状组）。64例无下肢动脉硬化患者作为对照组，比较3组血脂、C反应蛋白（CRP）的差异．及服用辛伐他汀18个月后血脂、CRP水平的变化。同时应用彩色多普勒超声比较下肢动脉斑块的变化。结果治疗组治疗前总胆固醇（TC）、低密度脂蛋白胆固醇（LDL-C）、CRP水平分别为（6．3±1．7）mmol／L、（3．8±1．3）mmol／L和（5．7±1．5）mmol／L，对照组分别为（5．2±1．3）mmol／L、（2．1±1．3）mmol／L和（3．3±1．4）mool／L，二者相比较差异有统计学意义（均为P〈0．05），治疗组经辛伐他汀治疗18个月后TC、LDL-C、CRP水平比较，[分别为（5．3±1．2）mmol／L、（2．9±1．6）mmol／L和（4．6±1．1）mmol／L]与治疗前差异有统计学意义（P〈0．05）。多普勒超声显示，治疗组治疗18个月后斑块大小自身比较，差异无统计学意义（P〉0．05），但临床症状减轻或消失，发生跛行症状的行走距离延长[治疗前（31．7±22．8）m，治疗后（41．2±26．7）m，P〈0．05]。无症状组18个月后自身斑块大小比较，差异有统计学意义（P〈0．05），且LDLC及CRP水平升高。结论下肢动脉硬化患者进行降脂治疗可以延缓动脉硬化进展，CRP可作为病情发展及监测的早期指标。

Objective To evaluate the therapeutic effects of simvastatin in elderly patients with lower extremity atherosclerosis disease. Methods One hundred and twenty-eight patients were divided into 2 groups： 64 cases with intermittent claudication （group 1） and 64 asymptomatic cases with intermittent claudication （group 2）. Sixty-four normal cases were served as control group （group 3）. The patients of group 1 were given simvastatin for 18 months. The differences in levels of blood lipids and C-reactive protein （CRP）, the size of plaque and the changes between pre-and post treatments were observed among three groups. Results TC, LDL-C and CRP levels were significantly higher in group 1 than those in group 3 before the treatment [（6.3± 1.7）mmol/L vs. （5.2± 1.3）retool/L,（3.8± 1.3）mmol/L vs. （2.1± 1.3）mmol/L,（5.7±1.5）mmol/L vs. （3.3± 1.4） mmol/L,respectively, all P〈0. 05]. TC, LDL-C and CRP levels significantly decreased in group 1 after 18 months＇ treatment [（5. 3±1. 2）mmol/L, （2.9±1.6）mmol/L,（4.6±1.1）mmol/L], all P〈 0.05]. There were no differences in plaque size and in plaque number in group 1 between pre and post treatments （both P 〉 0.05 ）, but the clinical symptoms were relieved or disappeared. There were significant differences in plaque size, blood lipid level and CRP level in group 2 after 18 months＇ treatment （all P〈0.05）. Conclusions Simvastatin can delay the development of artherioselerosis in the patients with lower extremity atherosclerosis disease. CRP can be used as an early index of disease development and illness monitoring.