瑞舒伐他汀对高血压合并颈动脉硬化患者颈动脉斑块及脑缺血事件影响的前瞻性研究

A prospective study of the effect of rosuvastatin on carotid artery plaque and cerebral ischemic events in patients with hypertension and carotid atherosclerosis

目的通过应用瑞舒伐他汀对高血压合并颈动脉斑块的患者进行干预,观察其对血脂、斑块及缺血性卒中发生率的影响。方法选取2013年5月—2015年5月就诊于邯郸市第一医院存在颈动脉斑块的高血压患者255例,随机分为对照组、瑞舒伐他汀低规剂量组(观察1组)和常规剂量组(观察2组),每组85例,均给予降压治疗及生活方式干预,对照组口服与瑞舒伐他汀相同外观的安慰剂1片,观察1组口服瑞舒伐他汀5 mg/d,观察2组口服瑞舒伐他汀10 mg/d,随访6个月。治疗前及治疗后检测血脂、血压,颈部血管超声检测颈动脉内膜-中膜厚度(iatima-media thickness,IMT)、斑块面积和Crouse斑块积分。比较治疗6个月后的脑缺血事件发生率。结果对照组治疗前、后各指标水平比较差异无统计学意义(P>0.05);治疗后观察1组、观察2组收缩压、舒张压均较治疗前下降,但差异无统计学意义(P>0.05);观察1组、观察2组治疗后TC水平较治疗前明显下降,IMT、斑块面积、Crouse积分、易损斑块率较治疗前降低,差异均有统计学意义(P<0.05),且观察2组各指标改善较观察1组明显(P<0.05)。结论瑞舒伐他汀除具有降脂作用外,还能逆转和稳定斑块,减少缺血性卒中事件的发生,且与剂量呈正相关。

Objective To investigate the effect of rosuvastatin intervention on blood lipid level, carotid artery plaque and cerebral ischemic events in patients with hypertension and carotid atherosclerosis. Methods A total of 255 hypertensive patients with carotid plaques in our hospital between May,2013 and May,2015 were prospectively included, and randomly divided into control group,low dose rosuvastatin group （ observation group 1 ） and routine dose group （ observation group 2）, with 85 cases in each group. All the three group were given antihypertensive therapy and lifestyle intervention, while the control group received 1 tablet of placebo which had the same the appearance of rosuvastatin, the observe group 1 received rosuvastatin 5 mg/day, and the observe group 2 received rosuvastatin 10 mg/day. The follow up was 6 months. Before and after the treatment, the blood lipids levels, blood pressure and carotid artery intima media thickness （ IMT）, plaque area and Crouse plaque score were detected. The incidence of ischemic events after 6 months of treatment was compared. Results The indexes of the control group showed no significant difference before and after treatment （ P 〉 0.05 ） ; after treatment, the systolic blood pressure and diastolic blood pressure observation of group 1 and observation group 2 de- creased compared with prior treatment, but there was no statistical significance （ P 〉 0.05 ） ; the level of TC, LDL-C in Observation group 1, Observation group 2 was declined than before; the level of IMT, plaque area, Crouse plaque score, The rate of vulnerable plaque were elevated than before, with statistical significance（ P 〈 0.05 ）. The index improvement is obvious in Observation group 2 than Observation group. Conclusion In addition to hypolipidemic effects,Rosuvastatin can also reverse and stabilize the plaque,reduce the incidence of ischemic stroke, and is positively correlated with the dose.