冠状动脉CT血管造影评价阿托伐他汀对轻中度冠状动脉狭窄斑块逆转作用研究

Observation of the reverse effect of atorvastatin on angina plaque in patients with mild-to-moderate coronary artery stenosis by coronary artery computed tomography

目的评价阿托伐他汀对轻中度冠状动脉狭窄的稳定型心绞痛患者的斑块逆转作用。方法对2011年11月至2012年6月沈阳军区总医院收治的42例冠状动脉CT显示冠状动脉轻中度狭窄的稳定型心绞痛患者随机分为2组：阿托伐他汀20mg组22例，阿托伐他汀40mg组20例。所有患者于入院前已完成冠脉cT血管造影（CTA），并接受冠状动脉造影（CAG）和靶病变的血管内超声（IVUS）检查，冠状动脉CT与冠状动脉造影及血管内超声相符合者入选。每位患者选取1处狭窄30％-60％的病变为靶病变进入观察，于术后6—12个月后行冠状动脉CTA评价，比较治疗前后冠状动脉靶病变的斑块面积。结果阿托伐他汀20mg组低密度脂蛋白胆固醇（LDL—c）由（3．44±0．42）mmol／L降至（2．31±0．19）mmo]／L，总胆固醇（TC）由（5．89±1．48）mmoVL降至（3．37±0．21）mmol／L；阿托伐他汀40mg组LDL—C由（3．52±0．43）mmol／L降至（1．83±0．17）mmol／L，TC由（5．99±1．28）mmol／L降至（3．17±0．10）mmol／L。斑块面积在入院时两组差异无统计学意义。降脂治疗后阿托伐他汀20mg组斑块面积由（13．16±4．79）mm。减少至（12．28±2．36）mm。（P=0．37）；阿托伐他汀40nlg组斑块面积由（13．81±4．52）mm。减少至（9．93±2．28）mm。（P〈0．01）。结论40mg／d阿托伐他汀可以使冠状动脉轻中度狭窄的稳定型心绞痛患者的斑块面积减少，可以阻止冠状动脉斑块的进展，效果好于20mg／d阿托伐他汀。

Objective To evaluate reversal effect of atorvastatin on angina plaque in patients with mild-to-moderate coronary artery stenosis. Methods Forty-two stable angina cases with mild-to-moderate coronary artery stenosis observed by coronary artery computed tomography （CT） were randomly divided into two groups ,treated with 20 mg and 40 mg atorvastatin, respectively. All patients had received CT angiography （ CTA）, coronary artery angiography （CAG） and intravaseular ultrasound （IVUS） examination before admission. Patients whose CTA results were consistent with CAG/IVUS were enrolled. We selected a 30% - 60% lesion in every patient that served as the target lesion. The coronary artery plaque area was compared before and after treatment （6 - 12 months） by CTA. Results The level of low-density lipoprotein cholesterol （ LDL- C） in patients treated with 20 mg atorvastatin reduced from （3.44 ±0. 42）mmol/L to （2. 31± 0. 19）mmol/L,and also did the level of total cholesterol （TC） from （5.89 ±1.48 ） mmol/L to （ 3.37 ±0. 21 ） mmol/L. The level of LDL-C in patients treated with 40 mg atorvastatin reduced from （ 3.52±0. 43 ） mmol/L to （ 1.83 ±0. 17 ） retooL/L, and also did TC from （5.99 ± 1.28）mmol/L to （3.17 ± 0. 10）mmol/L. The plaque area at admission was not significantly different between the two groups. The plague area of patients treated with 20 mg atorvastatin was decreased from （ 13. 16 ±4. 79） mm2 to （12. 28 ± 2. 36）mm2 （P =0. 37）, and the plague area of patients treated with 40 mg atorvastatin was decreased from （13.81 ±4. 52 ） mm2 to （ 9. 93 ± 2.28）mm2（P〈0.01）.Conclusion Atorvastatin at a dose of 40 mg/d can reduce the angina plague area in patients with mild-to-moderate coronary artery stenosis, and the effect is superior to that of 20 mg/d atorvastatin.