阿托伐他汀与辛伐他汀对老年颈动脉粥样硬化干预的对比分析

Study of intervention with atorvastatin and simvastatin on carotid atherosclerosis in old patients

目的探讨他汀类药物对老年颈动脉粥样硬化斑块的影响和对急性心脑血管事件的干预作用及机制。方法选择老年颈动脉粥样硬化患者61例,随机分为阿托伐他汀组(30例)及辛伐他汀组(31例),随访6个月。分别在治疗前及治疗后6个月,经颈动脉超声观察颈动脉内膜中层厚度(IMT)、斑块积分和斑块面积的变化,测血C反应蛋白、尿微量蛋白、血脂、生化指标的变化,记录心脑血管事件发生率。结果阿托伐他汀组治疗6个月后,颈总动脉IMT、斑块积分及斑块面积较治疗前明显降低(P<0.01);而辛伐他汀组治疗6个月后,颈总动脉IMT、斑块积分及斑块面积较治疗前虽有降低,但差异无统计学意义(P>0.05);2组治疗后C反应蛋白较治疗前明显降低(P<0.01)。在6个月的随访观察期间,阿托伐他汀组急性心脑血管事件发生率为13.3%,辛伐他汀组为22.6%,差异无统计学意义(P>0.05)。结论在抑制动脉粥样硬化逆转粥样硬化斑块及抑制斑块内炎性反应、减少急性心脑血管事件中,阿托伐他汀较辛伐他汀可能更具有优势。

Objective To explore the effect and mechanism of atorvastatin and simvastatin on carotid atherosclerosis in old patients. Methods Sixty-one old patients with carotid atherosclerosis were randomized into atorvastatin （n = 30） and simvastatin treatment groups （n = 31） for six months. Intima-media thickness（IMT） of carotid artery, carotid plaques score, carotid plaques are- a,CRP,urinary microalbumin（MALb）,serum lipids were detected before and after treatment for six months. Results IMT of carotid artery, carotid plaques score and carotid plaques area in the atorvastatin group were reduced significantly after treatment compared with those before treatment. However there was no significant reduction in simvastatin group. CRP in both groups was significantly reduced after treatment. Overall incidence of cardio- and cerebro-vasular events in atorvastatin group was 13.3% and in simvastatin group was 22.6%. Conclusion Lang-term atorvastatin treatment in delaying and reversing the progression of carotid atherosclerosis,improving inflammatory reaction and reducing cardio-and cerebro-vascular events was superior to simvastatin treatment.