不同剂量瑞舒伐他汀对冠心病患者血脂水平、肱动脉内皮依赖性舒张功能及颈动脉内膜中层厚度的影响

摘要

目的：探讨不同剂量瑞舒伐他汀对冠心病患者血脂水平、肱动脉内皮依赖性舒张功能（ flow-mediated vasodilation， FMD）及颈动脉内膜中层厚度（ intima-media thickness，IMT）的影响。方法选取东阳市人民医院药剂科收治的冠心病患者92例，随机数字表达法分为4组，其中对照组23例，予硝酸脂类、抗血小板凝集、抗凝、降血糖、控制血压等常规治疗；A组23例，在常规治疗的基础上加用瑞舒伐他汀5 mg／d，口服，每天1次；B组23例，在常规治疗的基础上加用瑞舒伐他汀10 mg／d，口服，每天1次；C组23例，在常规治疗的基础上加用瑞舒伐他汀20 mg／d，口服，每天1次。4组患者治疗8周。采用彩色多普勒超声仪检测各组患者治疗前后肱动脉FMD和IMT，同时观察各组患者血脂水平变化。结果对照组经过8周治疗后，FMD、ITM值及血脂各指标水平均未明显改变，差异无统计学意义；治疗后A、B、C 3组患者总胆固醇（ TC）、低密度脂蛋白胆固醇C（ LDL-C）水平明显较治疗前好转，差异有统计学意义（P＜0.05），且下降幅度随着瑞舒伐他汀剂量的增加而加大；但甘油三酯（TG）、高密度脂蛋白胆固醇C（HDL-C）水平与治疗前不存在显著差异；与治疗前相比，A、B、C 3组患者FMD值均有明显增高，差异有统计学意义（ P＜0.05），且增高幅度随着瑞舒伐他汀剂量的增加而加大；与治疗前相比，A、B、C 3组患者ITM值明显下降，差异有统计学意义（P＜0.05），且随着瑞舒伐他汀剂量的增加ITM值下降幅度增大。结论瑞舒伐他汀能够显著改善冠心病患者FMD和IMT，且存在明显的量效关系，这可能与瑞舒伐他汀能够显著降低冠心病患者总胆固醇和低密度脂蛋白胆固醇C有关。%Objective To investigate effect of different doses of rosuvastatin on brachial artery endothelium-dependent vasodilation and carotid intima-media thickness in patients with coronary heart disease.Methods 92 patients with coronary heart disease in our hospital were admitted and divided into four groups according to randomly digital method, including 23 cases in control group were treated with lipid nitrate, antiplatelet aggregation, anticoagulant, lowering blood sugar, blood pressure control and other of conventional therapy;23 cases in group A, on the basis of conventional therapy, were treated with rosuvastatin 5 mg/d, orally, once daily;23 cases in group B were treated with rosuvastatin 10 mg/d, orally, once daily based on the conventional therapy;23 cases in group C were treated with rosuvastatin 20 mg/d, orally, once daily based on conventional treatment, each group was treated for 8 weeks.Brachial artery endothelium-dependent vasodilation (FMD) and carotid intima-media thickness (IMT) of patients before and after treatment were collected by color ultrasonic doppler, while observed lipid levels changes of 4 groups.Results Control group was treated for eight weeks, FMD, ITM, blood lipid levels and each index values were not significantly changed, the difference was not statistically significant;After treatment, total cholesterol ( TC) , low-density lipoprotein cholesterol C ( LDL-C) of A, B, C groups were significantly better than that before treatment, the difference was statistically significant (P<0.05), and decrease amplitude with dose of rosuvastatin increased became grearer, but the total cholesterol (TC), high density lipoprotein cholesterol C( HDL-C) there was no significant difference compared with before treatment; Compared with before treatment, ITM of A, B, C groups decreased, and the difference was statistically significant (P<0.05), decrease amplitude with dose of rosuvastatin increased became greater.Conclusion Rosuvastatin can significantly improve brachial artery endothelium-dependent vasodilation and carotid intima-media thickness in patients with coronary heart disease, and there is a clear dose-response relationship, which may be associated with rosuvastatin decrease total cholesterol and low-density lipoprotein cholesterol C in patients with coronary heart disease.It has guide significance to clinical.