不同剂量阿托伐他汀对稳定性斑块的影响
불동제량아탁벌타정대은정성반괴적영향
The effect of different loading doses of atorvastatin in patients with stable plaques
  • 万方数据
    中国综合临床 중국종합림상
    CLINICAL MEDICINE OF CHINA
    2013年 2期 142-145 ,共4页

    高长征%郭素峡

    고장정%곽소협

    稳定性斑块%阿托伐他汀%血脂%超敏C反应蛋白%斑块体积%血管内超声虚拟组织学 穩定性斑塊%阿託伐他汀%血脂%超敏C反應蛋白%斑塊體積%血管內超聲虛擬組織學
    은정성반괴%아탁벌타정%혈지%초민C반응단백%반괴체적%혈관내초성허의조직학
    Stable plaques%Atorvastatin%Lipid%High-sensitivity C-reactive protein%Plaque volumes%Virtual histology intravascular ultrasound
    目的 探讨不同剂量阿托伐他汀对稳定性斑块的影响.方法 入选经冠状动脉造影和血管内超声检查确定为稳定性斑块的174例患者,分为4组:阿托伐他汀10 mg组47例,阿托伐他汀20 mg组45例,阿托伐他汀40 mg组43例,阿托伐他汀80 mg组39例,随访3～6个月,观察给予他汀药物的4组低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、超敏C反应蛋白(hs-CRP)、坏死核所占百分比及斑块体积的动态变化.结果 各组患者LDL-C、HDL-C、hs-CRP、坏死核所占百分比及斑块体积的基线水平是相近的(P均＞0.05).随访3～6个月后(1)阿托伐他汀治疗的4组LDL-C与基线相比均有明显下降(t值分别为3.12、4.23、3.26、5.21,P均＜0.01),且阿托伐他汀20 mg组和40 mg组治疗后两组间LDL-C不同(P＜0.05)；(2)阿托伐他汀10、20、40 mg组治疗后HDL-C与基线比较差异均无统计学意义,但阿托伐他汀80 mg组HDL-C明显高于其余3组(P均＜0.05),同时高于基线(t=2.35,P＜0.01)；(3)阿托伐他汀80 mg治疗后hs-CRP较基线显著下降[分别为(3.59±1.07) mg/L与(6.10±2.12) mg/L,t =2.37,P＜0.01]；(4)通过血管内超声虚拟组织成像技术(IVUS-VH)检测,斑块坏死核所占百分比在阿托伐他汀10 mg组明显高于基线[16.54±1.76)％与(7.83±1.03)％,t=2.38,P＜0.01],提示斑块向不稳定进展(坏死核所占百分比＞10％定义为不稳定性斑块),在阿托伐他汀20、40、80 mg组与基线相比无进展(t值分别为1.24、0.21、0.69,P值分别为0.069、0.846、0.643)；(5)斑块体积在阿托伐他汀10、20 mg组与基线相比无增大,但是在阿托伐他汀40、80 mg组斑块体积明显缩小[(30.69 +8.12) mm3与(37.09±12.01) mm3,t=1.29,P=0.019;(24.99±1.01) mm3与(36.47±14.68) mm3,t=2.62,P＜0.01].结论 不同剂量阿托伐他汀对稳定性斑块疗效不同.(1)对于LDL-C,20 mg/d阿托伐他汀就能使LDL-C降低达标,但40 mg/d阿托伐他汀降低幅度明显优于20 mg/d,与80mg/d相似.(2)对于HDL-C,只有80 mg/d阿托伐他汀能使之升高.(3)给予80 mg/d阿托伐他汀能使hs-CRP下降.(4)≥20 mg/d阿托伐他汀有稳定斑块的作用,80 mg/d优于40 mg/d及20 mg/d,而且40～80 mg/d阿托伐他汀有逆转斑块的作用.
    목적 탐토불동제량아탁벌타정대은정성반괴적영향.방법 입선경관상동맥조영화혈관내초성검사학정위은정성반괴적174례환자,분위4조:아탁벌타정10 mg조47례,아탁벌타정20 mg조45례,아탁벌타정40 mg조43례,아탁벌타정80 mg조39례,수방3～6개월,관찰급여타정약물적4조저밀도지단백담고순(LDL-C)、고밀도지단백담고순(HDL-C)、초민C반응단백(hs-CRP)、배사핵소점백분비급반괴체적적동태변화.결과 각조환자LDL-C、HDL-C、hs-CRP、배사핵소점백분비급반괴체적적기선수평시상근적(P균＞0.05).수방3～6개월후(1)아탁벌타정치료적4조LDL-C여기선상비균유명현하강(t치분별위3.12、4.23、3.26、5.21,P균＜0.01),차아탁벌타정20 mg조화40 mg조치료후량조간LDL-C불동(P＜0.05)；(2)아탁벌타정10、20、40 mg조치료후HDL-C여기선비교차이균무통계학의의,단아탁벌타정80 mg조HDL-C명현고우기여3조(P균＜0.05),동시고우기선(t=2.35,P＜0.01)；(3)아탁벌타정80 mg치료후hs-CRP교기선현저하강[분별위(3.59±1.07) mg/L여(6.10±2.12) mg/L,t =2.37,P＜0.01]；(4)통과혈관내초성허의조직성상기술(IVUS-VH)검측,반괴배사핵소점백분비재아탁벌타정10 mg조명현고우기선[16.54±1.76)％여(7.83±1.03)％,t=2.38,P＜0.01],제시반괴향불은정진전(배사핵소점백분비＞10％정의위불은정성반괴),재아탁벌타정20、40、80 mg조여기선상비무진전(t치분별위1.24、0.21、0.69,P치분별위0.069、0.846、0.643)；(5)반괴체적재아탁벌타정10、20 mg조여기선상비무증대,단시재아탁벌타정40、80 mg조반괴체적명현축소[(30.69 +8.12) mm3여(37.09±12.01) mm3,t=1.29,P=0.019;(24.99±1.01) mm3여(36.47±14.68) mm3,t=2.62,P＜0.01].결론 불동제량아탁벌타정대은정성반괴료효불동.(1)대우LDL-C,20 mg/d아탁벌타정취능사LDL-C강저체표,단40 mg/d아탁벌타정강저폭도명현우우20 mg/d,여80mg/d상사.(2)대우HDL-C,지유80 mg/d아탁벌타정능사지승고.(3)급여80 mg/d아탁벌타정능사hs-CRP하강.(4)≥20 mg/d아탁벌타정유은정반괴적작용,80 mg/d우우40 mg/d급20 mg/d,이차40～80 mg/d아탁벌타정유역전반괴적작용.
    Objective To investigate the effect of different loading doses of atorvastatin in patients with stable plaques.Methods Consecutive 174 patients with stable plaque who underwent coronary arteriongraphy (CAG) and intravascular unltrasound(IVUS) were randomly assigned to receive 10 mg atorvastatin treatment (group 10 mg,n =47),20 mg atorvastatin treatment(group 20 mag,n =45),40 mg atorvastatin treatment (group 40 mg,n =43) and 80 mg atorvastatin treatment (group 80 mg,n =39).The endpoints including low density lipoprotein-cholesterol(LDL-C),high density lipoprotein-cholesterol (HDL-C),high-sensitivity C-reactive protein (hs-CRP) levels,necrotic and plaque volumes,were assessed after 3-6 months' follow-up.Results Mean LDL-C,HDL-C,hs-CRP,the percentage of necrotic,plaques volumes were similar at baseline (P ＞ 0.05).During 3-6 months of follow up:(1)LDL-C levels in group 10 mg,20 mg,40 mg,80 mg were lower than at baseline (t =3.12,4.23,3.26 and 5.21 respectively,P ＜ 0.01).There was significant difference between the 20 mg group and the 40 mg group(P ＜ 0.05) ; (2) There was no significant difference of HDL-C levels in 10 mg,20 mg and 40 mg groups after atorvastatin treatment.However,its level was significantly higher in the 80 mg group after atorvastatin treatment than other dose groups(P ＜ 0.05) and were higher than at baseline(t =2.35,P ＜ 0.01) ;(3)the 80 mg group's hs-CRP levels decreased significantly after treatment than at baseline((3.59 + 1.07)mg/L vs (6.10 + 2.12) mg/L,t =2.37,P ＜ 0.01);(4)According to the VH of IVUS,the percentage of necrotic in 10 mg group became higher than at baseline ((16.54 + 1.76) ％ vs.(7.83 + 1.03) ％,t =2.38,P ＜0.01) and conformed to unstable plaques diagnostic criteria(＞ 10％).There was no significant difference in group 20 mg,40 mg and 80 mg with at baseline (t =1.24,0.21,0.69 respectively,P =0.069,0.846,0.643respectively) ; (5)Plaques volumes in group 10 mg,20 mg were not larger than at baseline.However,in group 40mg and 80 mg.Plaques volumes were smaller than at baseline ((30.69 ± 8.12) mm3 vs (37.09 + 12.01)mm3,t=l.29,P=0.019;(24.99±l.01) mm3 vs (36.47+14.68) mm3,t =2.62,P＜0.01).Conclusion The effects of atorvastatin on stable plaques vary with doses.(1) For LDL-C,the use of atorvastation 20 mg/d can make LDL-C reaching standard,and atorvastation 40 mg/d was superior to 20 mg/d and similar to 80 mg/d.(2)For HDL-C,atorvastation 80 mg/d can make it higher.(3)Atorvastation 80 mg/d can make hs-CRP lower.(4)Atorvastation≥20 mg/d can make plaques stable and atorvastation 80 mg/d was superior to 20 mg/d and 40mg/d.Atorvastation 40-80 mg/d can make plaques dwindled.
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