瑞舒伐他汀治疗慢性肾脏病晚期颈动脉粥样斑块的临床研究

Clinical research of treatment to carotid atherosclerosis with rosuvastatin in stage 4～5 chronic kidney disease

目的研究瑞舒伐他汀钙对慢性肾病晚期患者颈动脉粥样斑块的疗效。方法选取彩超证实存在颈动脉粥样斑块的慢性肾脏病4～5期患者90例,随机分为三组:A组给予瑞舒伐他汀钙5 mg.d-1,B组给予瑞舒伐他汀钙10 mg.d-1,C组给予阿托伐他汀钙10 mg.d-1,三组年龄和性别相匹配。比较治疗前及治疗12个月后总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白-胆固醇(LDL-C)、高密度脂蛋白-胆固醇(HDL-C)、超敏C反应蛋白(hs-CRP)、肝功能(ALT)、肌酸激酶(CK)水平以及颈动脉内膜中层厚度、粥样斑块数目、大小。结果三组治疗前血脂、hs-CRP水平及颈动脉粥样斑块情况无显著性差异(P>0.05)。三组患者治疗前后比较,治疗后TC、TG、LDL-C、hs-CRP水平均明显下降(P<0.01),HDL-C水平明显升高(P<0.01),其中B组患者血脂及hs-CRP的变化水平较A、C组明显(P<0.01);颈动脉中层厚度治疗后低于治疗前,但仅B组有统计学意义(P<0.05),治疗前后斑块数目无明显改变,B组斑块治疗后较治疗前缩小,A、C组无明显变化。结论常规剂量的瑞舒伐他汀钙可通过调脂、抑制炎症反应等可能机制逆转慢性肾脏病晚期患者颈动脉粥样斑块,并具有良好的安全性。

Objective To investigate the effects of rosuvastatin on carotid atherosclerosis plaques in patients with stage 4/5 chronic kidney disease.Methods A total of 90 stage 4~5 chronic kidney disease patients with carotid atherosclerosis plaques were randomized to rosuvastatin 5 mg·d-1（group A,n=30）,rosuvastatin 10 mg·d-1（group B,n=30） and atorvastatin 10 mg·d-1（group C,n=30） for twelve months.The three groups matched for age and gender.The blood lipids including total cholesterol,triglyceride,low density lipoprotein cholesterol and high density lipoprotein cholesterol,highly sensitive C-reactive protein,hepatic function（ALT）,creatine kinase（CK）,the intima-media thickness（IMT） of carotid arteries,plaque morphology were evaluated before and after treatment.Results The blood lipids levels,the hs-CRP,and the carotid atherosclerosis plaques of three groups before treatment had no significant differences（P0.05）.The TC,TG,LDL-C,hs-CRP levels of three groups after treatment for 12 months were significantly decreased compared with before treatment（P0.01）,while the HDL-C was increased（P0.01）.The change of B group was more apparent than A and C group（P0.01）.The IMT after treatment was thinner than before treatment,and there was no significant difference except that in B group（P0.05）.After treatment,the count of plaques was not statistically significant among three groups,while the size was significantly decreased in B group.Conclusion Rosuvastatin（10 mg·d-1） can reverse the carotid atherosclerosis plaques in patients with stage 4~5 chronic kidney disease safely.