降脂治疗逆转冠状动脉粥样硬化

Regression of coronary atherosclerotic plaque with lipid-lowering therapy

目的通过血管内超声了解氟伐他汀和阿托伐他汀降脂治疗对冠状动脉粥样斑块退缩及其成分的影响。方法经冠状动脉造影(CAG)证实至少有一支主要冠状动脉存在20%～50%狭窄(目测)的70名患者,利用Excel表格按1∶1比例随机分为阿托伐他汀(20mg/d,35例)组和氟伐他汀(80mg/d,35例)组。通过血管内超声灰阶成像(C-IVUS)和虚拟组织学成像(VH-IVUS)脱机分析软件分别测量降脂治疗12个月前后冠状动脉粥样硬化斑块、血管、管腔体积及成分的变化。结果 56例(80%)患者完成全部随访过程,阿托伐他汀组及氟伐他汀组各28例。经过12个月的降脂治疗,阿托伐他汀组低密度脂蛋白胆固醇(LDL-C)由(3.43±0.65)mmol/L降至(2.11±0.41)mmol/L(P<0.001),下降(36.9±14.7)%;氟伐他汀组LDL-C由(3.36±0.69)mmol/L降至(2.75±0.85)mmol/L(P=0.002),下降(16.1±30.3)%,两组间LDL-C下降幅度差异有统计学意义(P=0.002)。阿托伐他汀组斑块体积由(351.0±152.2)mm3减至(314.4±112.9)mm3(P=0.001),下降(8.5±12.9)%;氟伐他汀组斑块体积由(294.6±87.6)mm3增至(308.4±91.5)mm3(P=0.001),增加(4.7±9.2)%,组间斑块体积变化的百分比差异有统计学意义(P<0.001)。阿托伐他汀组斑块体积下降百分比与LDL-C下降百分比呈正相关(r=0.586,P=0.001)。坏死核心(NC)比例阿托伐他汀组由(13.8±3.9)%下降至(10.8±6.9)%(P=0.023),而氟伐他汀组由(12.7±3.4)%增至(15.0±7.8)%(P=0.111),组间NC比例变化差异有统计学意义(P=0.006)。结论阿托伐他汀20mg降脂治疗可显著缩小冠状动脉粥样斑块体积,并可减少斑块坏死核心比例,斑块体积下降百分比与LDL-C下降百分比呈正相关,而氟伐他汀80mg不能阻止冠状动脉粥样硬化进展。

Objective To study the effects on on plague regression and plaque contents via serial intravascular ultrasound（IVUS）after administration of fluvastatin and atorvastatin.Methods Seventy patients with at least one major coronary artery≥20-50% diameter stenosis by visual estimation according to coronary angiography were studied and randomly divided into two groups：atorvastatin（20 mg/d,35 patients）and fluvastatin（80 mg/d,35 patients）groups.The change of the vessel,lumen and plaque volumes of coronary atherosclerosis plaque,and the change of plaque composition（defined as follow-up minus baseline）were generated by using dedicated off-line analysis software for the gray-scale intravascular ultrasound imaging（conventional IVUS gray-scale images,C-IVUS）and intravascular ultrasound virtual histology imaging（virtual histology intravascular ultrasound,VH-IVUS）,respectively.Results Among the total of 70 patients,clinical and IVUS follow-up were available in 56 patients（80%,28 cases in each group）.By the end of 12 months,low-density lipoprotein cholesterol（LDL-C）level in the atorvastatin group decreased from 3.43±0.65mmol/L to 2.11±0.41 mmol/L,with a reduction of-36.9±14.7%,compared to the fluvastatin group（from 3.36±0.69mmol/L to 2.75±0.85 mmol/L,with a reduction of-16.1±30.3%,P=0.002）.Plaque volume in the atorvastatin group reduced from 351.0±152.2 mm3 at baseline to 314.4±112.9 mm3 at 12-month（a reduction of 8.5±12.9%）,which is significantly different to the fluvastatin group（from 294.6±87.6 mm3 to 308.4±91.5 mm3,a reduction of ＋4.7±9.2%,P0.001）.In the atorvastatin group,the plaque volume reduction showed a significant positive correlation with decrease in LDL-C level（r=0.586,P=0.001）.Proportion of the necrosis core（NC）in the atorvastatin group decreased from 13.8±3.9% at baseline to 10.8±6.9% at 12-month（P=0.023）,with no significant difference observed in the fluvastatin group（from 12.7±3.4 % to 15.0±7.8%,P = 0.111）.Conclusions Lipid-lowering therapy by 20mg atorvastatin for 12 months significantly reduced coronary atherosclerosis plaque volume and the proportion of necrotic core.The percentage of plaque volume decrease showed a significant positive correlation with LDL-C level reduction in the atorvastatin group,while 80 mg fluvastatin could not prevent the progression of atherosclerosis in our study.