阿托伐他汀联合缬沙坦对冠状动脉临界病变患者心血管的保护作用
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武警医学院院级课题(200812)


Protective Effection of Atorvastatin Combined with Valsartan on Cardiovascular Patients with Coronary Borderline Lesions
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    摘要:

    目的观察64层螺旋CT诊断为冠状动脉临界病变的患者给予阿托伐他汀联合缬沙坦治疗半年后冠状动脉斑块的变化,探讨他汀类联合血管紧张素Ⅱ受体拮抗剂抑制炎性反应、稳定冠状动脉斑块的协同作用。方法经64层螺旋CT诊断为冠状动脉临界病变的患者116例,分为单纯治疗组(56例,给予阿托伐他汀治疗)和联合治疗组(60例,给予阿托伐他汀和缬沙坦联合治疗),分别检测两组患者治疗前后血浆高敏C反应蛋白和脑钠肽的水平,半年后复查冠状动脉64层螺旋CT,观察冠状动脉斑块的变化。结果治疗后,两组患者血浆脑钠肽及高敏C反应蛋白水平均降低,与治疗前相比差异有显著性(P><0.01),且联合治疗组较单纯治疗组降低更显著(P><0.05);两组左心室射血分数与治疗前相比明显提高(P><0.01),且联合治疗组较单纯治疗组提高更明显(P><0.05);同时复查64层螺旋CT,脂质斑块明显减小,纤维斑块和混合斑块略有缩小,分别与治疗前相比差异有统计学意义(P><0.05),两组相比较联合治疗组缩小幅度更明显(P><0.05),钙化斑块两组均无明显变化。结论应用他汀类降脂药联合血管紧张素Ⅱ受体拮抗剂加强了抑制炎症反应、稳定冠状动脉斑块的作用。

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    Aim To investigate the combined therapeutic effects of statins(atorvastatin) and angiotensin receptor blocker(ARB,valsartan) for six months on patients with coronary borderline lesions confirmed by 64-row multi-detector computed tomography(MDCT),with emphasis on systemic inflammatory response and imaging characteristics of coronary plaques. Methods 116 patients with borderline coronary lesions detected by MDCT were enrolled and divided into two groups: single-treatment group(56 patients) and combined-treatment group(60 patients).In single treatment group,patients were received atorvastatin,and patients of combined-treatment group were treated with atorvastatin and valsartan.Plasma high sensitive C-reaction protein(hs-CRP) and brain natriuretic peptide(BNP) were examined before and after treatment in each group,and coronary artery lesions was rechecked by MDCT to evaluate the change of coronary artery plaques after six months of treatment. Results Significant decreases were observed in plasma hs-CRP and BNP after treatment in both groups(P><0.01),and patients in combined-treatment group exhibited more significant decreases than single-treatment group(P><0.05).Left ventricular ejection fractions(LVEF) in all patients were significantly elevated(P><0.01),and patients of combined-treatment group showed more significant improvement than single-treatment group(P><0.05).In addition,MDCT showed a significant reduction of lipid plaque volume and only a slight reduction in both fibrous plaque volume and mixed plaque volume after treatment(P><0.05),and patients in combined-treatment group exhibited more significant decreases than single-treatment group(P><0.05).However,there was no significant change in calcified plaque of both groups.Incidence of adverse cardiovascular events in combind-treatment group was significantly lower than single-treatment group. Conclusion Combination of statins and ARB for six months can significantly inhibit systemic inflammatory response and stabilize coronary plaques.

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赵季红,李玉明,李学文,梁国庆,陈少伯,姜铁民.阿托伐他汀联合缬沙坦对冠状动脉临界病变患者心血管的保护作用[J].中国动脉硬化杂志,2010,18(12):975~978.

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  • 收稿日期:2010-09-21
  • 最后修改日期:2010-11-22
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