依泽替米贝联合阿托伐他汀对动脉粥样硬化斑块的影响

Effects of ezetimibe combined with atorvastatin on atherosclerotic plaque

目的:本研究选择阿托伐他汀联合依泽替米贝与单一阿托伐他汀药物治疗对比,评估联合用药对血脂和冠状动脉粥样硬化斑块消退的影响。方法:采用前瞻性、随机性的方法,将冠脉造影确诊为冠心病的患者随机分为阿托伐他汀组和阿托伐他汀联合依泽替米贝组。阿托伐他汀组以患者血清中低密度胆固醇浓度(LDL-C)<70 mg·dL-1为治疗目标。用药9个月后,采用血管内超声定量冠状动脉内斑块,检测血液中相关参数。结果:阿托伐他汀联合依泽替米贝用药组与单独阿托伐他汀用药组相比,前者LDL-C明显降低[(60.5±19.8)mg·dL-1 vs.(79.8±17.9)mg·dL-1,P<0.01)]。与单一用药相对比,双联降血脂药物对斑块体积变化具有显著的优越性(-1.3±0.09 vs.-0.3±0.05,P<0.01)。血液中LDL-C浓度的降低幅度和斑块的消退程度具有显著相关性(R=0.207,P<0.05)。结论:阿托伐他汀联合依泽替米贝与阿托伐他汀用药相比,双联降脂药可以显著降低血清中LDL-C浓度,同时加速动脉粥样硬化斑块的消退。

OBJECTIVE To investigate clinical effects of atorvastatin or atorvastatin combined with ezetimibe on lipid and coronary atherosclerosis in Chinese population. METHODS This trial adopted prospective and random design, screened pa- tients by coronary angiography. Eligible patient were randomly divided to receive atorvastatin or atorvastatin combined with ezetimibe. Patients in atorvastatin group had low density lipoprotein cholesterol （LDL-C） concentrations 〈70 mg· dL-1 as therapeutic target. After 9 months of treatment, intravascular ultrasound was utilized to quantitatively determine coronary plaque and detect blood-related parameters. RESULTS Combined atorvastatin/ezetimibe resulted in lower levels of LDL-C than atorvastatin monotherapy （60. 5 ± 19. 8 mg·dL-1 vs. 79. 8± 17. 9 mg·dL-1 , P〈0. 01）. Absolute change in PAV showed su- perior for dual lipid-lowering strategy （ - 1.3 ± 0. 09 vs. - 0. 3 ± 0. 05, P〈0. 01） with atorvastatin alone. Blood LDL choles- terol concentrations and degree of plaque regression had significant correlation （R = 0. 207, P〈0. 05）. （X）NCLUSION Combi- nation of atorvastatin and ezetimibe shows greater coronary plaque regression compared with atorvastatin monotherapy, and it simultaneously accelerates elimination of atherosclerotic plaques.