阿托伐他汀联合辅酶Q10治疗颈动脉斑块临床观察

Atorvastatin combined with coenzyme QIO in the treatment of carotid atherosclerotic plaque： a double-blind, randomized control study

目的探讨阿托伐他汀联合辅酶Q10对颈动脉斑块的治疗效果。方法127例颈动脉斑块患者按照随机数字表法分为对照组（n=42）、阿托伐他汀组（n=42）和阿托伐他汀＋辅酶Q10组（n=43），分别接受常规治疗、阿托伐他汀和阿托伐他汀＋辅酶Q10治疗，治疗6个月后行超声心动图和CT血管成像（CTA）检查，随访颈动脉内一中膜厚度（IMT）、斑块体积、颈总动脉内径及颈动脉狭窄率，并观察用药不良反应。结果治疗6个月后，阿托伐他汀组及阿托伐他汀＋辅酶Q10组IMT及斑块体积均较治疗前及对照组治疗后明显减小，差异有统计学意义（P〈0．05），且阿托伐他汀＋辅酶Q10组较阿托伐他汀组IMT及斑块体积减小更明显，差异有统计学意义（P〈0．05）。阿托伐他汀组及阿托伐他汀＋辅酶Q10组患者颈总动脉内径[（6．4±0．8）mm与（6．7±1．0）mm]均大于本组治疗前[（5．8±0．6）mm与（5．9±0．5）mm]及对照组治疗后[（6．0±0．7）mm]，差异有统计学意义（P〈0．05或P〈0．01），颈动脉狭窄率低于治疗前及对照组治疗后，差异有统计学意义（P〈0．05或P〈0．01），而阿托伐他汀＋辅酶Q10组患者颈总动脉内径增大及颈动脉狭窄率减小较阿托伐他汀组更明显，差异有统计学意义[颈总动脉内径：（6．7±1．0）mill比（6．4±0．8）inln；颈动脉狭窄率：（22±3）％比（37±4）％，均P〈0．05]。对照组治疗后各指标无明显变化。阿托伐他汀组3例患者出现乏力，2例肌痛，对照组及阿托伐他汀＋辅酶Q10组无一例发生不良反应。结论阿托伐他汀联合辅酶Q10能有效延缓斑块进展及颈动脉狭窄，并缓解由阿托伐他汀引起的肌痛和乏力，值得临床借鉴应用。

Objective To explore the therapeutic effect of atorvastatin combined with coenzyme Q10 （CoQ10） in the treatment of carotid atheroselerotic plaque. Methods A total of 127 patients with carotid atherosclerotic plaque were divided into control group （ n = 42 ） , atorvastatin group （ n = 42 ） and atorvastatin ＋ CoQ10 group （n = 43 ） at random, and received routine therapy, atorvastatin and atorvastatin combined with CoQ10 respectively. The intima-media thickness （IMT） , plaque volume, carotid artery diameter and rate of carotid stenosis were followed up after 6 months by using ultrasound and CT angiography （ CTA）, and the adverse drug reactions were also observed. Results After 6 months, the IMT and plaque volume of atorvastatin group and atorvastatin ＋ CoQ10 group were statistically decreased than those before treatment and in control group （ P 〈 0. 05 ）, and the atorvastatin ＋ CoQ10 group showed a better decrease （ P 〈 0. 05 ）. The diameter of carotid artery in atorvastatin group and atorvastatin ＋ CoQ10 group [ （ 6.4 ± 0. 8 ） mm and （ 6. 7 ± 1.0 ） mm, respectively] was significantly increased and the rate of carotid stenosis was obviously decreased than that before treatment and in control group （ P 〈 0. 05 or P 〈 0. 01 ）, and the atorvastatin ＋ CoQ10 group showed a better improvement [ （ 22 ± 3 ） % vs （ 37 ± 4） % ,P 〈 0.05 ]. No change of any indexes was observed in control group. Three patients had hypodynamia and 2 patients had myosalgia in atorvastatin group. No other adverse drug reactions were observed in control group and atorvastatin ＋ CoQ10 group. Conclusion Atorvastatin combined with CoQ10 can effectively delay plaque progress and carotid stenosis for patients with carotid atherosclerotic plaque, and also release myosalgia and hypodynamia caused by atorvastatin.