多层螺旋CT评价他汀类药物对冠状动脉非钙化斑块的疗效

Therapeutic Evaluation of Non-calcified Coronary Plaques with Statins by Multi-slice Spiral Computed Tomography

目的以多层螺旋CT评价他汀类药物治疗后,冠状动脉非钙化性斑块密度、体积及血管狭窄程度的变化,评估他汀类药物的疗效。资料与方法前瞻性研究80例多层螺旋CT检查发现的冠状动脉非钙化斑块患者,按低密度脂蛋白(LDL-C)水平、是否接受他汀类药物治疗分为治疗组和对照组,均于1年后CT复查主要斑块密度、体积和管腔狭窄程度及血脂变化。结果治疗组血清LDL-C治疗前(3.65±0.56)mmol/L、治疗1年后(2.32±0.24)mmol/L,三酰甘油(TG)治疗前(2.15±0.44)mmol/L、治疗1年后(1.86±0.31)mmol/L,治疗后两者水平下降,较治疗前差异有统计学意义(P<0.05);治疗组高密度脂蛋白(HDL-C)治疗前(1.28±0.33)mmol/L、治疗1年后(1.31±0.41)mmol/L,治疗前后差异无统计学意义(P>0.05)。对照组治疗1年后LDL-C水平下降,差异有统计学意义(P<0.05),但HDL-C、TG水平变化差异无统计学意义(P>0.05)。治疗组治疗1年后脂质斑块密度(51±12)HU,较治疗前升高,差异有统计学意义(P<0.05),血管狭窄程度均较治疗前下降,差异均有统计学意义(P<0.05)。治疗组纤维斑块密度和对照组脂质斑块、纤维斑块密度均无显著变化(P>0.05);治疗组斑块体积由(87.3±19.2)mm^3下降至(75.6±14.2)mm^3,差异有统计学意义(P<0.05),而斑块长度、厚度无显著变化(P>0.05)。结论多层螺旋CT可量化评价冠状动脉非钙化斑块经他汀类药物治疗后的变化,他汀类药物能够有效调整血脂从而逆转或稳定冠状动脉非钙化斑块。

Purpose To evaluate the therapeutic effect of statins on non-calcified coronary plaques by multi-slice computed tomography（MSCT）.Materials and Methods In this prospective study,eighty patients with non-calcified coronary plaques were enrolled and divided into study cohort and comparison cohort based on the level of low density lipidcholesterol（LDL-C） and whether to accepted statins treatment.All patients were examined by computed tomography coronary angiography before and 12 months after treatment.The level of blood lipid,plaque changes and vessel stenotic degree were compared,respectively.Results In the statins cohort,the mean level of LDL-C between pre and post treatment was（3.65±0.56） mmol/L and（2.32±0.24） mmol/L,triglycerides（TG） was（2.15±0.44） mmol/L and（1.86±0.31） mmol/L.There was statistical difference between pre and post treatment respectively（P〈0.05）.And the mean level of high density lipid-cholesterol（HDL-C） in treatment group was（1.28±0.33） mmol/L and（1.31±0.41） mmol/L before and after treatment,the change in HDL-C was statistically insignificant（P〉0.05）.In the comparison cohort,the level of LDL-C decreased（P〈0.05） and HDL-C,TG were not changed（P〉0.05）.The density of lipid plaque was raised（51±12） HU compared with pretreatment（P〈0.05）.The degree of coronary stenosis decreased in the treatment group（P〈0.05） and mild stenosis and significant stenosis were decreased.The fibrous plaque density in treatment group and plaque density,coronary stenosis degree in non-treatment group were not changed（P〉0.05）.The plaque volume in treatment group fall to（75.6±14.2） mm^3 from（87.3±19.2） mm^3（P〈0.05）,while the length and thickness were unchanged（P〉0.05）.Conclusion MSCT can assess the changes of non-calcifiedcoronary plaques after statins therapy quantitatively.Statins therapy can regulate blood lipid,reverse and stabilize coronary artery plaques effectively.