阿托伐他汀强化降脂治疗颈动脉粥样硬化斑块疗效分析

Analysis on the efficacy of atorvastatin intensive lipid-lowering treatment of carotid atherosclerotic plaque

目的评价大剂量阿托伐他汀强化降脂治疗颈动脉粥样硬化斑块临床效果。方法选取2012年4月—2013年5月间到郑州大学第五附属医院神经内科就诊的颈动脉粥样硬化斑块病变患者104例,随机分为强化降脂治疗组和常规治疗组,强化降脂治疗组采用阿托伐他汀60mg/d,常规治疗组采用阿托伐他汀10mg/d。用药9个月后,评价治疗前后两组患者血脂、高敏C-反应蛋白变化情况、颈动脉斑块变化情况,以及不良反应发生情况。结果 91例(87.5%)完成了整个治疗和随访过程,两组患者治疗后TG、TC、LDL-C、hs-CRP均较治疗前降低,HDL-C水平较治疗前升高,差异均具有统计学意义(P<0.05);强化治疗组治疗后IMT(1.34±0.52)和斑块面积(19.41±0.45)较治疗前IMT(1.62±0.21)和斑块面积(21.61±0.31)减少,差异均具有统计学意义(P<0.05);强化治疗组治疗后IMT(1.34±0.52)和斑块面积(19.41±0.45)与常规治疗组治疗后的IMT(1.59±0.34)和斑块面积(21.94±0.51)进行比较,显著降低,差异均具有统计学意义(P<0.05)。强化治疗组总不良反应发生率为21.3%,高于对照组的9.1%,主要不良反应为转氨酶升高,占10.6%。结论大剂量阿托伐他汀强化治疗颈动脉粥样硬化斑块安全有效,可以延缓或者逆转斑块形成。

Objective To investigate the efficacy of high-dose atorvastatin intensive lipid lowering treatment of carotid atherosclerotic plaque. Methods 104 cases of patients with carotid atherosclerotic plaque, hospitalized in the department of Neu-rology, were selected from April 2012 to May 2013 at the Fifth Affiliated Hospital of Zhengzhou University. All the cases were randomly divided into intensive lipid-lowering therapy group and conventional treatment group. Intensive lipid-lowering treatment group received atorvastatin 60mg/d, the conventional treatment group received atorvastatin 10mg/d. After 9 months treatment, the lipids, high-sensitivity C-reactive protein changes, changes in carotid plaques, as well as adverse events were evaluated before and after the treatment. Results 91 cases （87.5%） completed the treatment and follow-up. After treatment, TG, TC, LDL-C and hs-CRP were lower than those before treatment, while HDL-C was increased, the differences were all statistically significant （ P〈0.05）. Before treatment, IMT （1.34±0.52）and plaque area（19.41±0.45,after treatment IMT（1.62±0.21）and plaque area （21.61± 0.31）,that in the intensive treatment group were more decreased than before treatment, the differences were statistically significant （P〈0.05）. The total incidence of adverse reactions was 21.3% in the intensive treatment group, higher than 9.1% in the control group. The mainly reactions were elevated aminotransferases , accounting for 10.6%. Conclusion High-dose atorvastatin intensive treatment of carotid atherosclerotic plaque was safe and effective, could delay or reverse plaque formation.