他汀类药物预处理对不稳定性心绞痛斑块破裂发生的影响

Impact of statin pretreatment on the incidence of plaque rupture in patients with unstable angina pectoris

目的 观察冠心病患者在使用他汀类药物后对斑块破裂及不稳定性心绞痛（UAP）发生的影响.方法 采用回顾性病例对照研究方法,分析62例冠心病患者的血脂异常率、他汀类药物治疗率以及治疗后低密度脂蛋白胆固醇（LDL-C）达标率;比较各组冠心病他汀类药物治疗患者的UAP发生率;应用血管内超声（IVUS）测量、分析责任血管狭窄病变处、近端参考血管、远端参考血管外弹力膜截面积、斑块破裂、钙化斑块比例及冠状动脉重构情况.结果 非他汀组患者LDL-C未达标率为96.4%（27/28）,应获得而未得到他汀类药物治疗率为46.4%（13/28）;他汀组患者LDL-C达标率为26.5%（9/34）.他汀组UAP发生率显著低于非他汀组（χ2=34.491,P=0.001）,他汀组LDL-C达标者与未达标者UAP发生率比较差异无统计学意义（χ2=0.002,P=0.968）.他汀组LDL-C显著低于非他汀组（2.457±0.802 vs 3.218±1.130,Z=-9.760,P=0.001）;他汀组未达标患者LDL-C水平显著低于非他汀组未达标患者（2.816±0.640 vs 3.370±0.963,F=-3.613,P=0.001）.他汀组斑块破裂的发生率低于非他汀组（38.2% vs 60.7%,χ2=3.107,P=0.150〉0.05）,正性重构率亦明显低于非他汀组（29.4% vs 46.4%,χ2=1.905,P=0.09〉0.05）.结论 他汀类药物治疗冠心病患者UAP发生率显著降低.使用他汀治疗可使斑块破裂减少,其独立于冠脉重构之外.他汀类药物治疗的最主要效果在于预防动脉粥样硬化斑块的破裂.

Objective To investigate the effect of statin pretreatment on the incidence of plaque rupture and unstable angina pectoris （UAP）deteeted by intravaseular ultrasound（IVUS） in patients with coronary heart disease （CHD）. Methods A retrospective case control study was conducted. Prevalence of abnormal blood fat content, sta- tin treatment rate, and attainment rate of low density lipoprotein-cholesterol（LDL-C） lowered to expected level in 62 patients with CHD were analyzed. Relationship between statin therapy and level of LDL-C were analyzed by multivari- ate general linear factorial analysis. The incidence of unstable angina peetoris （UAP） was compared in patients with CHD receiving statin therapy in all groups. IVUS interrogation was performed before pereutaneous coronary interven- tion. Results Prevalence of abnormal LDL-C was 96.4% （27/28） in CHD patients of non-statin therapy group, and 46.4% （ t3/28 ） of patients with CHD should receive statin therapy but did not. Attainment rate of lowering of LDL-C to expected level in statin therapy group was 26. 5% （9/34）. LDL-C level （mmol/L） was significantly lower in statin therapy group than in non-statin therapy group（2. 457 ＋0. 802 vs 3.218 ＋ 1. 130, Z = -9. 760,P =0. 001 ） ,and inci- dence of UAP was significantly lower in statin therapy group than in non-statin therapy group（32. 3% vs 71.4%, χ2 = 34. 491 ,P =0. 001 ）. There was no difference between patients with and without attaining the expected low value of LDL-C in statin therapy group（33.3% vs 32% , χ2 = 0. 002 ,P = 0. 968 ）. Plaque ruptures were detected in 30 patients（30/62）. Patients with statin pretreatment（ n = 34） had a lower incidence of plaque rupture than those without （38.2% vs 60. 7% , χ2 = 7. 3, P = 0. 007）. Positive remodeling was also lower in patients with stain pretreatment than those without （29. 4% vs 46. 4% , X2 = 3.06, P = 0.04）. Conclusion Incidence of UAP was significantly de- crease after statin treatment in patients with CHD. It should be considered as the key treatment in CHD. Statin pre- treatment before onset of UAP is associated with a lower plaque rupture, suggesting that the prevention of plaque rupture may be a esueial mechanism underlying clinical benefits associated with statins.