血管内超声评价国产瑞舒伐他汀对冠状动脉轻中度狭窄病变的影响

Effects of domestic rosuvastatin on coronary plaque in patients with mild-to-moderate coronary artery stenosis as evaluated by virtual histology-intravascular ultrasound

目的应用虚拟组织学一血管内超声（VH．IVUS）评价国产瑞舒伐他汀对急性冠脉综合征患者冠状动脉轻中度狭窄病变斑块进展及成分的影响。方法选择经冠状动脉造影（CAG）和VH-IVUS检查无需介入治疗的冠脉轻中度狭窄病变患者83例，分为试验组42例和对照组41例，试验组给予国产瑞舒伐他汀（瑞旨10mg，每晚1次），对照组给予进口瑞舒伐他汀（可定10mg，每晚1次），治疗6个月后复查血脂、CAG及VH-IVUS，比较两组问血脂变化、定量冠脉造影分析靶病变处直径狭窄（DS）变化，VH-IVUS分析靶病变处斑块负荷、最小管腔面积（MLA）和斑块成分变化。结果瑞舒伐他汀干预6个月后，VH-IVUS分析显示，两组患者斑块坏死核心比例比治疗前明显减少（试验组：14．8％±7．0％比22．6％±7．5％，P〈0．05，对照组：14．9％±7．1％比23．1％±7．7％，P〈0．05）、纤维组织比例明显增加（试验组：51．5％±9．9％比44．5％±9．7％，P〈0．05，对照组：51．4％±10．1％比44．3％±9．8％，P〈0．05），两组患者血脂水平明显改善（P〈0．05），而DS、斑块负荷、MLA、纤维脂质组织比例、钙化组织比例无明显变化（P〉0．05）。结论国产瑞舒伐他汀治疗冠脉轻中度狭窄病变可稳定斑块，并延缓斑块进一步发展。

Objective To evaluate the effects of domestic rosuvastatin tablets on coronary plaque in the patients with mild-to-moderate coronary artery stenosis through virtual histology-intravascular ultrasound （VH-IVUS）. Methods Eighty-three patients with mild-to-moderate coronary artery stenosis of acute coronary syndrome（ACS）were enrolled and randomized into test group （domestic rosuvastatin, 10 mg/day, n =42） or control group （ CRESTOR, 10 mg/day, n =41 ）. The serum lipid levels, diameter stenosis （DS） on quantitative coronary angiography （QCA）, MLA （minimal lumen area）, plaque burden and component of target lesion on VH-IVUS were evaluated at baseline and at 6-month follow-up. Results After 6 months, the levels of total cholesterol （ TC）, low density lipoprotein cholesterol （LDL-C） and triglyceride （TG） significantly decreased while the high density lipoprotein cholesterol （HDL-C） level significantly increased in two groups （ P 〈 0. 05 ）. VH-IVUS analysis showed that the proportion of necrotic core significantly decreased （ domestic rosuvastatin ： 14. 8%± 7.0% vs 22. 6%± 7.5% , P 〈 0. 05, crestor： 14. 9% ± 7. 1% vs 23.1% ±7.7%, P 〈 0. 05 ） and the proportion of fibrous tissue significantly increased （domestic rosuvastatin： 51.5% ±9.9% vs44.5%±9.7%, P〈0.05, crestor： 51.4% ＋10.1% vs 44.3%±9.8%, P〈0.05） in two groups. There were no significant changes in DS, plaque burden, MLA or the proportion of dense calcium and fibro-fatty tissue of target lesion in two groups （P 〉 0. 05 ）. And no significant differences existed in serum lipid levels, DS, MLA, plaque burden and component between two group（ P 〉0. 05 ）. Conclusion The 6-month treatment of rosuvastatin may stabilize the atherosclerosis plaque and prevent its progression in patients with mild-to-moderate coronary artery stenosis.