CAJ | 학술논문

目的探讨多重危险因素干预与老年人颈动脉粥样硬化和斑块的关系,评估强化他汀降脂治疗重要性、安全性、有效性及达标剂量. 方法入组181例经彩色颈动脉超声检查确诊为颈总动脉内中膜(IMT)增厚和颈动脉粥样硬化斑块伴有多重危险因素患者.数字抽签随机分为2组给予综合控制血脂、血压、血糖等,常规治疗组阿托伐他汀10 mg,强化治疗组阿托伐他汀20 mg,治疗24个月. 结果两组患者干预后的血压、血脂、血糖、微量白蛋白尿(MAU)及超高敏C反应蛋白(hs-CRP)较治疗前均有改善(P％0.05或P＜0.01)；强化治疗组总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)及hs-CRP差值分别为(0.9±0.6) mmol/L,(1.3±0.7)mmol/L、(3.9±3.0) mg/L,常规治疗组分别为(0.3±0.3) mmol/L、(1.0±0.6) mmol/L、(2.9±1.9) mg/L,差异有统计学意义(均P＜0.01).强化治疗组颈动脉IMT、颈动脉斑块的性质改善(P＜0.01)；斑块个数两组均减少,强化治疗组的变化趋势更显著(P＜0.01)；强化治疗组颈动脉双侧斑块面积均改善(P＜0.05). 结论多重危险因素综合干预治疗,可稳定、延缓颈动脉粥样硬化及斑块,老年人常规剂量他汀治疗可使LDLC达到目标值.
목적 탐토다중위험인소간예여노년인경동맥죽양경화화반괴적관계,평고강화타정강지치료중요성、안전성、유효성급체표제량. 방법 입조181례경채색경동맥초성검사학진위경총동맥내중막(IMT)증후화경동맥죽양경화반괴반유다중위험인소환자.수자추첨수궤분위2조급여종합공제혈지、혈압、혈당등,상규치료조아탁벌타정10 mg,강화치료조아탁벌타정20 mg,치료24개월. 결과 량조환자간예후적혈압、혈지、혈당、미량백단백뇨(MAU)급초고민C반응단백(hs-CRP)교치료전균유개선(P％0.05혹P＜0.01)；강화치료조총담고순(TC)、저밀도지단백담고순(LDL-C)급hs-CRP차치분별위(0.9±0.6) mmol/L,(1.3±0.7)mmol/L、(3.9±3.0) mg/L,상규치료조분별위(0.3±0.3) mmol/L、(1.0±0.6) mmol/L、(2.9±1.9) mg/L,차이유통계학의의(균P＜0.01).강화치료조경동맥IMT、경동맥반괴적성질개선(P＜0.01)；반괴개수량조균감소,강화치료조적변화추세경현저(P＜0.01)；강화치료조경동맥쌍측반괴면적균개선(P＜0.05). 결론 다중위험인소종합간예치료,가은정、연완경동맥죽양경화급반괴,노년인상규제량타정치료가사LDLC체도목표치.
Objective To investigate the association between multiple risk factor intervention and carotid atherosclerosis in the elderly,to explore the intervention strategies for carotid atherosclerosis,and to assess the importance,safety,effect and standard dose of the statin in lipidlowering therapy.Methods 181 patients with increased carotid artery intima media thickness (IMT) and carotid atherosclerotic plaque diagnosed by color ultrasonography were randomly divided into conventional therapy group (atorvastatin 10 mg daily for 24 months) and intensive-therapy group (atorvastatin 20 mg daily for 24 months),and lipids,blood pressure,blood glucose and other factors were comprehensively controlled.Results Compared with before treatment,the levels of blood pressure,lipids,blood glucose,microalbunminuria (MAU) and high sensitive C-reactive protein (hsCRP) were improved after treatment in the two groups (P＜0.05 or 0.01).There were sigificant differences in the decrease levels of total cholesterol (TC),low-density lipoprotein cholesterol (LDLC),hs CRP between intensive therapy group and conventional therapy group after 24-month treatment [(0.9±0.6) mmol/Lvs.(0.3±0.3) mmol/L,(1.3±0.7) mmol/Lvs.(1.0±0.6) mmol/L,(3.9±3.0) mmol/L vs.(2.9±1.9) mmol/L,all P＜0.01].The improvements in carotid artery IMT and carotid artery plaque properties were more significant in intensive-therapy group than in conventional therapy group after treatment (P＜0.01).The number of carotid artery plaques was decreased in the two groups,while the decrease trend was more significant in intensive-therapy group than in conventional-therapy group after treatment (P ＜ 0.01).Bilateral plaque areas were significantly decreased in intensive therapy group after treatment (P＜0.05).Conclusions Carotid atherosclerosis can be stabilized and delayed by comprehensive multiple risk factor intervention in elderly patients.LDL-C can reach the target value with the conventional dose statin therapy in the elderly.