低密度脂蛋白胆固醇控制目标值与颈动脉斑块退缩的相关性研究

Correlation between control target of low density lipoprotein cholesterol and carotid atherosclerotic plaque regression

目的探讨动脉粥样硬化性缺血性脑卒中或短暂性脑缺血发作(TIA)患者低密度脂蛋白胆固醇(LDL-c)控制目标值与颈动脉斑块退缩的相关性。方法 2014年6月至2016年6月于福建医科大学附属第一医院选择100例伴有颈动脉斑块的缺血性脑卒中或TIA患者为研究对象,应用他汀类药物治疗6个月,比较治疗前后血LDL-c数值、颈动脉内膜中层厚度(CIMT)、最长斑块的长径及厚度、斑块规则性及回声特征的差异;以他汀类药物治疗6个月后血LDL-c值1.8 mmol/L或2.07 mmol/L为目标值进行分组,比较颈动脉二维超声中斑块参数变化。结果 (1)他汀类药物治疗前最长斑块的长径为1.17(0.69)cm,治疗后最长斑块的长径为0.99(0.89)cm,差异具有统计学意义(P<0.05),斑块的规则性及回声特征在治疗前后的差异无统计学意义(P>0.05)。(2)以1.8 mmol/L为LDL-c控制目标值分组,他汀类药物治疗后LDL-c≤1.8 mmol/L组的最长斑块长径为0.90(0.91)cm,较治疗前基线水平1.11(0.46)cm减少18.9%(P<0.05);LDL-c>1.8 mmol/L组的最长斑块的长径与基线水平相比无明显变化。(3)以2.07 mmol/L为LDL-c控制目标值分组,他汀类药物治疗后最长斑块的长径无明显变化(P>0.05)。结论动脉粥样硬化性缺血性脑卒中或TIA患者应用他汀类药物治疗6个月,LDL-c控制目标值≤1.8 mmol/L,颈动脉二维超声发现最长斑块的长径减少。

Objective To investigate the correlation between low density lipoprotein cholesterol(LDL-c)control target and carotid atherosclerotic plaque regression in patients with atherosclerotic cerebral ischemic stroke/transient ischemic attack(TIA). Methods 100 atherosclerotic ischemic stroke/TIA patients with carotid atherosclerotic plaque were enrolled in the First Affiliated Hospital of Fujian Medical University between June 2014 and June 2016,after 6 months of statin therapy,the values of serum LDL-c,bilateral carotid intima-media thickness(CIMT),length and thickness of the longest plaque 、regularity and echo characteristics of the target plaque were compared with the baseline. And LDL-c value of 1.8 or 2.07 mmol/L was used as the target level to compare the changes of plaque parameters in two-dimensional ultrasound of carotid artery after 6 months of treatment with statins. Results The length of the longest plaque before statin treatment was 1.17(0.69) cm,and after treatment with statins the value was 0.99(0.89) cm,the difference was significant(P<0.05).There was no statistic difference in plaque regularity and echo characteristics before and after treatment(P > 0.05). When using LDL-c1.8 mmol/L as the target level after treatment with statins,the length of the longest plaque in LDL-c ≤ 1.8 mmol/L group was 0.90(0.91) cm, decreased by 18.9%compared with the baseline level 1.11(0.46)cm(P<0.05). The length of the longest plaque in LDL-c >1.8 mmol/L group had no significant change compared with the baseline. When using LDL-c 2.07 mmol/L as the target level after treatment with statins,there was no significant change in the length of the longest plaque. Conclusion After treatment with statins for 6 months,with LDL-c level control target≤1.8 mmol/L,the length of the longest plaque of carotid artery in atherosclerotic ischemic stroke/TIA patients decreased by ultrasound.