不同剂量氟伐他汀消退老年颈动脉粥样斑块

Regression of carotid atherosclerotic plaques in elderly patients with different doses of fluvastatin

目的：观察不同剂量氟伐他汀对老年患者颈动脉粥样硬化斑块的消退作用。方法：经彩色多普勒超声仪证实存在颈动脉粥样硬化斑块92例本院患者，经8周氟伐他汀40mg／d洗脱期后，随机分为A组（氟伐他汀40mg／d，n=48）及B组（氟伐他汀80mg／d，n=44），共治疗48周；观察两组治疗前后颈动脉粥样斑块面积、总胆固醇（TC）及低密度脂蛋白胆固醇（LDL—C）的变化。结果：经氟伐他汀治疗48周后，A、B两组的颈动脉粥样硬化斑块面积分别由干预前的（0．20±0．18）cm^2，（0．20±0．19）cm^2。显著缩小为（0．12±0．15）cm^2，（0．114-0．12）cm^2（均P〈0．05）；B组较A组能进一步缩小斑块面积，但未达统计学意义（P〉0．05）。A组血TC（3．82±O．89）mmol／L、LDL—C（2．27±0．66）mmol／L浓度较治疗前的（4．25±1．03）mmoL／L，（2．68±0．71）mmol／L有显著性下降（均P〈0．05）；B组血TC（2．57±0．89）mmol／L、LDL—C（1．28±0．5）mmol／L的浓度均较治疗前的[（4．24±1．11）mmol／L，（2．63±0．88）mmoL／L]有显著性下降（均P〈0．05）。结论：氟伐他汀有消退老年颈动脉粥样斑块的作用，大剂量氟伐他汀治疗在缩小斑块面积方面较小剂量组更具优越性；颈动脉粥样硬化患者应行积极的血脂干预，以预防脑卒中的发生及复发。

Objective： To investigate the regression of carotid atherosclerotic plaques in elderly patients with different doses of fluvastatin. Methods： A total of 92 patients with carotid atherosclerotic plaques detected by color doppler ultrasonography was divided randomly into groups A （n = 48 ） and B （n = 44 ） to be treated with fluvastatin 40 mg/day or 80 mg/d for 48 weeks, after an 8-week washout period. The change of carotid plaque areas, total cholesterol （TC） and low-density lipoprotein cholesterol （LDL-C） in the two groups after fluvastatin treatment were studied. Results：After 48 weeks＇ treatment with fluvastatin, the carotid plaque areas showed a significant reduction from baseline [（0.20±0.18）cm2 to （0.12±0.15）cm2 in groupAvs （0.20±0.19） cm2 to （0.11±0.12）cm2 in group B] （ all P 〈 0.05）. Group B seemed to be more benefited in reduction of plaque areas but this did not reach the level of statistical significance（P 〉 0.05 ）. The levels of blood TC, LDL-C after intervention [ （ 3.82 ± 0.89） mmol/L, （2. 27 ± 0.66） mmoL/L] were obviously lower than those before intervention [ （4.25± 1.03 ） mmol/L, （ 2.68 ±0.71 ） mmol/L ] （ P 〈 0.05 ） in group A, so were the levels of blood TC, LDL-C after intervention [ （2.57 ± 0.89 ） mmol/L, （ 1.28 ± 0. 5 ） mmol/L ] and before intervention [ （4.24±1. 11 ） mmol/L, （2.63±0. 88 ） mmol/L ] （ P 〈 0.05 ） in group B. Conclusion：Fluvastatin may lead to regression of carotid atherosclerotic plaque in elderly patients. Larger dose of fluvastatin may be more beneficial in reduction of plaque areas. Aggressive measures in blood lipids intervention should be considered for patients with carotid artery atherosclerosis in order to prevent stroke from oceurrenee and relapse.