CT评价他汀类药物对冠状动脉粥样硬化斑块进展的影响

Evaluation of the influence of statins on the coronary artery atherosclerosis plaque progression by CT scan

目的 探讨CT在他汀类药物对冠状动脉粥样硬化（CAS）斑块进展效果评价中的应用.方法选择经多排螺旋CT检查发现CAS斑块的220例冠心病（CHD）患者,给予阿托伐他汀钙（10 mg/次,1次/d）＋阿司匹林,12个月后随访CT复查斑块情况.根据治疗期间用药情况分为间断用药组（n=94）和规律用药组（n=126）,比较两组血脂改善情况,分析治疗前后斑块体积的变化.结果治疗后,两组患者各血脂指标均有不同程度改善,规律用药组TC、LDL-C水平较间断用药组显著降低[（3.26±0.55）mmol/L比（4.45±0.78）mmol/L、（1.72±0.38）mmol/L比（2.49±0.45）mmol/L]（P〈0.05）;规律用药组各种斑块体积均显著缩小,其中低密度斑块体积、 斑块总体积均显著小于间断用药组[（11.25±3.15）mm^3比（13.22±4.16）mm^3、（57.93±5.15）mm^3比（62.17±7.61）mm^3]（P〈0.05）;斑块总体积与TC、LDL-C均呈显著正相关（r=0.511,0.487,P〈0.05）.结论他汀类药物能够调节血脂水平,缩小CAS斑块体积.CT可定量、定性评价CAS斑块变化,能有效监测他汀类药物的治疗效果.

Objective To explore the application of CT in the evaluation of the influence of statins on the coronary artery atherosclerosis （CAS） plaque progression. Methods 220 CHD patients with CAS plaque found by multi-slice spiral CT were collected, all the patients were given Atorvastatin calcium （10 mg per time, once per day）＋Aspirin, CT reexamination was performed after follow-up of 12 months, according to the drug use during treatment, all the patients was divided into intermittent medication group （n=94）, regular medication group （n=126）. The improvement of blood lipid, the change of plaque volume before and after treatment between two groups were compared. Results After treatment, two groups of patients are improved, the indexes of blood lipid in both groups were improved to varying degrees, but the levels of TC, LDL-C in regular medication group were decreased more significantly than those in intermittent medication group [（3.26 ±0.55）mmol/L vs （4.45 ±0.78）mmol/L, （1.72±0.38）mmol/L vs （2.49±0.45）mmol/L]（P〈0.05）. After treatment, volumes of all kinds of plaques in reg-ular medication group were significantly reduced, volume of low density plaque and total plaque were significantly less than those in intermittent medication group[（11.25 ±3.15）mm^3 vs （13.22 ±4.16）mm^3, （57.93 ±5.15） mm^3 vs （62.17 ±7.61）mm^3]（P〈0.05）. Plaque total volume and TC, LDL-C was significantly positive correlated （r=0.511,0.487,P〈0.05）. Conclusion Statins can regulate level of blood lipid, reduce the CAS plaque volume. CT can evaluate the changes of CAS plaque quantitatively, qualitatively, effectively monitoring the therapeutic effect of statins.