他汀类降脂药联合血管紧张素Ⅱ受体拮抗剂治疗冠状动脉病变的临床研究

Clinical Investigation of Atorvastatin Combined With Valsartan in Patients With Coronary Borderline Lesions

目的:观察经64层螺旋计算机断层摄影术(CT)诊断为冠状动脉临界病变的患者给予阿托伐他汀联合缬沙坦治疗6个月后冠状动脉斑块的变化,探讨他汀类联合血管紧张素Ⅱ受体拮抗剂抑制炎性反应、稳定冠状动脉斑块的协同作用。方法:经64层螺旋CT诊断为冠状动脉临界病变的患者110例,随机分为两组:阿托伐他汀治疗组(A组)55例,阿托伐他汀+缬沙坦联合治疗组(B组)55例,分别检测两组患者治疗前、药物治疗6个月后,血浆高敏C反应蛋白水平以及冠状动脉斑块的变化情况。结果:药物治疗6个月后与治疗前相比,两组患者高敏C反应蛋白水平均降低(P均<0.01),且B组较A组降低显著(P<0.05),差异均有统计学意义。治疗后与治疗前相比,两组脂质斑块、混合斑块明显减小(P<0.05～0.01),差异均有统计学意义;纤维斑块和钙化斑块变化均不明显(P均>0.05)。B组与A组相比,脂质斑块、混合斑块缩小幅度更明显(P均<0.05),差异均有统计学意义;纤维斑块、钙化斑块变化不明显(P均>0.05)。结论:应用他汀类降脂药联合血管紧张素Ⅱ受体拮抗剂加强了抑制炎性反应、稳定冠状动脉斑块的作用。

Objective ： To investigate the combined medication of statins （atorvastatin） and angiotensin receptor blocker, valsartan for their inhibition effect to systemic inflammation response in patients with coronary borderline lesions. Methods： 110 patients with coronary borderline lesions diagnosed by 64-row multi-detector computed tomography（MDCT） were divided into two groups. Single medication group, n = 55, the patients received atorvastatin for 6 months, and Combined medi- cation group,n = 55,the patients received both atorvastatin and valsartan for 6 months. We examined the plasma high sensitivity C-reactive protein（hs-CRP） and compared the coronary artery lesions by MDCT before and after the treatment in all patients. Resuhs：Plasma hs-CRP decreased significantly in both groups after 6 months of treatment,P〈0. 01 respectively, and it was even lower in Combined medication group, P〈0. 05. MDCT presented an obvious reduction of lipid plaque volume and mixed plaque volume in both groups after the treatment, P〈0.05, while there were no real changes of fibrous plaque volume and calcified plaque volume after the treatment P〉0. 05. The patients in Combined medication group had more reduction in their lipid plaque volume and mixed plaque volume compared than that in Single medication group, P〈0. 05 respectively, but no obvious differences in fibrous plaque volume and calcified plaque volume between two groups ,P〉0.05 respectively. Conclusion：Combined medication of statins （atorvastafin）and angiotensin receptor blocker, valsartan, can inhibit the systemic inflammatory response and stabilize the coronary plaque in patients with coronary borderline lesions.