CAJ | 학술논문

目的：探讨不同剂量的阿托伐他汀钙对冠心病患者肱动脉内皮细胞功能的影响。方法冠心病患者159例，根据患者血清中低密度脂蛋白胆固醇（LDL-C）水平的不同，将入选的冠心病患者分为4组，并给予不同的药量，治疗8周。第1组：LDL-C≥4.15 mmol/L的患者36例，给予阿托伐他汀钙40 mg/d治疗（40 mg组）；第2组：3.65 mmol/L≤LDL-C＜4.15 mmol/L的患者42例，给予阿托伐他汀钙20 mg/d治疗（20 mg组）；第3组；2.6 mmol/L≤LDL-C＜3.65 mmol/L的患者44例，给予阿托伐他汀钙10 mg/d治疗（10 mg组）；第4组：LDL-C＜2.6 mmol/L的患者37例，不采用阿托伐他汀钙治疗（对照组）。应用彩色多普勒超声诊断仪测量受试者肱动脉血流介导的舒张功能（FMD）及硝酸甘油介导的舒张功能（NMD）。检测并比较血清总胆固醇、低密度脂蛋白、甘油三酯、高密度脂蛋白的水平。结果治疗前，前三组即阿托伐他汀钙干预治疗组（10 mg组、20 mg组、40 mg组）患者的肱动脉内径基础值、NMD及FMD水平，与对照组相比较均无显著性差异（P＞0.05）。经8周治疗后，比较前三组（40 mg组、20 mg组、10 mg组）患者的肱动脉内径的基础值、NMD与治疗前的水平及比较对照组与干预治疗组的NMD水平，均无显著性差异（P＞0.05）；而与治疗前相比较，FMD水平有明显增加，比对照组，FMD增加的趋势非常明显，差异有显著性（P＜0.05）。结论阿托伐他钙汀除可以降血脂，部分逆转动脉粥样硬化的程度之外，也可改善冠心病患者的血管内皮的功能，但其改善血管内皮功能的作用机制与改善血脂水平无明显的量效关系。
목적：탐토불동제량적아탁벌타정개대관심병환자굉동맥내피세포공능적영향。방법관심병환자159례，근거환자혈청중저밀도지단백담고순（LDL-C）수평적불동，장입선적관심병환자분위4조，병급여불동적약량，치료8주。제1조：LDL-C≥4.15 mmol/L적환자36례，급여아탁벌타정개40 mg/d치료（40 mg조）；제2조：3.65 mmol/L≤LDL-C＜4.15 mmol/L적환자42례，급여아탁벌타정개20 mg/d치료（20 mg조）；제3조；2.6 mmol/L≤LDL-C＜3.65 mmol/L적환자44례，급여아탁벌타정개10 mg/d치료（10 mg조）；제4조：LDL-C＜2.6 mmol/L적환자37례，불채용아탁벌타정개치료（대조조）。응용채색다보륵초성진단의측량수시자굉동맥혈류개도적서장공능（FMD）급초산감유개도적서장공능（NMD）。검측병비교혈청총담고순、저밀도지단백、감유삼지、고밀도지단백적수평。결과치료전，전삼조즉아탁벌타정개간예치료조（10 mg조、20 mg조、40 mg조）환자적굉동맥내경기출치、NMD급FMD수평，여대조조상비교균무현저성차이（P＞0.05）。경8주치료후，비교전삼조（40 mg조、20 mg조、10 mg조）환자적굉동맥내경적기출치、NMD여치료전적수평급비교대조조여간예치료조적NMD수평，균무현저성차이（P＞0.05）；이여치료전상비교，FMD수평유명현증가，비대조조，FMD증가적추세비상명현，차이유현저성（P＜0.05）。결론아탁벌타개정제가이강혈지，부분역전동맥죽양경화적정도지외，야가개선관심병환자적혈관내피적공능，단기개선혈관내피공능적작용궤제여개선혈지수평무명현적량효관계。
Objective To observe the influences of Atorvastatin in different doses on vascular endothelial function in patients with coronary atherosclerotic heart disease. Methods The patients (n=159) were divided, according to the lev?el of low-density lipoprotein-cholesterol (LDL-C), into 4 groups: 40 mg group (LDL-C≥4.16 mmol/L, n=36, treated with Atorvastatin, 40 mg/d), 20 mg group (3.64 mmol/L≤LDL-C<4.16 mmol/L, n=42, treated withAtorvastatin, 20 mg/d), 10 mg group (2.6 mmol/L≤LDL-C<3.64 mmol/L, n=44, treated with Atorvastatin, 10 mg/d) and control group (LDL-C<2.6 mmol/L, n=37, not treated with Atorvastatin). The changes of flow-mediateddilatation (FMD) and nitroglycerin-medi?ated dilatation (NMD) were detected by using color Doppler ultrasonic diagnostic apparatus. The levels of serum total cho?lesterol (TC), triglyceride (TG), LDL-C and high-density lipoprotein-cholesterol (HDL-C) were detected conventionally. Results Before treatment, the basis value of brachia diameter, FMD and NMD had no statistical difference between all Atorvastatin groups and control group (P>0.05). After treatment for 8 w, the basis value of brachia diameter and NMD had no statistical difference in all Atorvastatin groups (P>0.05) and FMD increased significantly, and thedifference was statistical?ly significant compared with control group (P<0.05). The difference in NMD had no statistically significance between all Atorvastatin groups and control group (P>0.05). Conclusion Atorvastatin can improve vascular endothelial function in patients with coronary atherosclerotic heart disease, and there is no dose-effect relationship in its mechanism of ameliorat?ing level of blood fat.