阿托伐他汀钙治疗动脉粥样硬化患者的临床研究

Clinical trial of atorvastatin calcium in the treatment of patients with atherosclerosis

目的 研究不同剂量阿托伐他汀钙治疗对动脉粥样硬化患者颈动脉内膜中层厚度(CIMT)和血清脂蛋白相关磷脂酶A2(Lp-PLA2)、氧化低密度脂蛋白(ox-LDL)、同型半胱氨酸(Hcy)水平的影响。方法 回顾性选取动脉粥样硬化患者的病历资料,根据治疗方案分为低剂量组(阿托伐他汀钙片20 mg·d^(-1))和高剂量组(阿托伐他汀钙片40 mg·d^(-1))。比较2组患者治疗前后血脂[三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)]水平和颈动脉粥样硬化斑块特征(CIMT、斑块面积)及血清Lp-PLA2、ox-LDL、Hcy水平,记录治疗期间药物不良反应发生情况。结果 低剂量组98例,高剂量组102例。治疗后,高剂量组、低剂量组的TG水平分别为(3.75±0.59)和(5.36±0.83)mmol·L^(-1),TC水平分别为(4.07±0.98)和(4.52±1.02)mmol·L^(-1),HDL水平分别为(1.89±0.58)和(1.49±0.42)mmol·L^(-1),LDL水平分别为(1.85±0.58)和(2.67±0.73)mmol·L^(-1),CIMT分别为(1.14±0.18)和(1.30±0.20)mm,斑块面积分别为(18.59±2.17)和(22.72±2.81)mm~2,血清Lp-PLA2水平分别为(116.27±28.46)和(135.74±25.03)μg·L^(-1),ox-LDL水平分别为(12.07±2.59)和(13.42±2.25)μg·L^(-1),Hcy水平分别为(11.92±3.12)和(15.21±3.06)μmol·L^(-1),在统计学上差异均有统计学意义(均P<0.05)。治疗期间,高剂量组、低剂量组的药物不良反应发生率分别为22.55%和14.29%(P>0.05)。结论 与低剂量阿托伐他汀钙相比,高剂量阿托伐他汀钙治疗动脉粥样硬化可更好地改善患者血脂水平,有助于缩小斑块,抑制炎症反应,干预动脉粥样硬化的形成,二者安全性相当。

Objective To investigate the effects of different doses of atorvastatin calcium on carotid intima-media thickness(CIMT) and serum lipoprotein associated phospholipase A2(Lp-PLA2),oxidized low-density lipoprotein(ox-LDL) and homocysteine(Hcy) levels in patients with atherosclerosis.Methods Patients with atherosclerosis were divided into low-dose group(atorvastatin calcium tablets,20mg·d^(-1)) and high-dose group(atorvastatin calcium tablets,40mg·d^(-1)) according to the treatment scheme.The levels of blood lipids[triglyceride(TG),total cholesterol(TC),high-density lipoprotein(HDL) and low-density lipoprotein(LDL)],carotid atherosclerotic plaque characteristics(CIMT and plaque area),serum Lp-PLA2,ox-LDL and Hcy levels were compared between groups.Adverse drug reactions in two groups were recorded.Results There were 98 cases in low-dose group,102 cases in high-dose group.After treatment,the levels of TG in high-dose group and low-dose group were(3.75±0.59) and(5.36±0.83) mmol·L^(-1);the levels of TC were(4.07±0.98) and(4.52±1.02) mmol·L^(-1);the levels of LDL were(1.89±0.58) and(1.49±0.42) mmol·L^(-1);the levels of and HDL were(1.85±0.58) and(2.67±0.73)mmol·L^(-1);CIMT were(1.14±0.18) and(1.30±0.20) mm;plaque areas were(18.59±2.17) and(22.72±2.81) mm~2;the levels of Lp-PLA2 were(116.27±28.46) and(135.74±25.03) μg · L^(-1);the levels of ox-LDL were(12.07±2.59) and(13.42±2.25) μg · L^(-1);the levels of Hcy were(11.92±3.12) and(15.21±3.06) μmol·L^(-1).The above indexes were significantly different between high-dose group and low-dose group(all P <0.05).The total incidence rates of adverse drug reactions in high-dose group and low-dose group were 22.55% and 14.29%(P> 0.05).Conclusion Compared with low-dose atorvastatin calcium,high-dose atorvastatin calcium can better improve blood lipid level of patients with atherosclerosis,reduce plaques,inhibit inflammatory reaction and reduce the formation of atherosclerosis.The two are comparably safe.