阿托伐他汀钙治疗80岁以上抗磷脂综合征患者缺血事件的研究

Research of atorvastatin calcium in the treatment for antiphospholipid syndrome in patients aged over 80

目的观察>80岁患者抗磷脂综合征(APS)的临床特点,探讨他汀类药物防治APS患者反复发生心脑血管缺血事件的作用。方法回顾我院老年科收治的15例>80岁患者反复出现心脑血管缺血事件的临床资料,在常规抗血小板、抗凝治疗的基础上每晚加服阿托伐他汀钙20mg,观察抗心磷脂抗体(aCL)滴度、氧化修饰型低密度脂蛋白(Ox-LDL)、血脂、血小板等指标的变化及随访心脑血管缺血事件发生率的情况。结果 >80岁APS患者总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)正常或偏低;但Ox-LDL偏高;治疗后aCL滴度下降或降至阴性,Ox-LDL降至正常,颈部动脉斑块稳定。随访12月,心脑血管缺血事件发生显著降低(P=0.0001)。结论阿托伐他汀钙能通过降低aCL和Ox-LDL的表达,抑制氧化应激效应等,稳定了血管内皮功能及斑块而发挥心脑血管保护作用。

Objective To observe the clinical features of antiphospholipid syndrome （APS） in patients aged over 80, and to approach the effects of statins on preventing and treating repeated relapse cardia and cerebral vessels ischemic events. Methods The clinical data of 15 patients with repeated relapse cardia and cerebral vessels ischemic events were retrospectively analyzed. The patients received atorvastatin calcium 20 mg per night on the basis of routine antiplatelet and anticoagulation treatment. The changes of the levels of anti-phospholipid antibody＇s tite （aCL）,oxidized low density lipoprotein （Ox-LDL）, blood fat,blood plate, and the occurrance of cardia and cerebral vessels ischemic events were observed. Results The levels of total cholesterol （TC）, triglyceride （TG）, low-density lipoprotein cholesterol （LDL-C）, high-density lipoprotein cholesterol （HDL-C） of the patients aged over 80 were normal or partially low. But the levels of Ox-LDL were high. After treatment the aCL titer was decreased or descended to negative, and Ox-LDL descended to normal level. The cervical artery plaques were stable. After 12 months＇ follow-up, the occurrence rate of cardia and cerebral vessels ischemic events was significantly decreased （P=0.001）. Conclusions Atorvastatin calcium can stabilize the function of blood vessel endothelium and the plaques, and protect cardia and cerebral vessels through lowering the expression of aCL and Ox-LDL and inhibiting oxidative stress effect.