辛伐他汀联合阿司匹林对早期动脉硬化伴血管内皮功能障碍患者的影响

摘要

目的：分析辛伐他汀联合阿司匹林对早期动脉硬化伴血管内皮功能障碍患者的干预作用。方法入选2011年1月~2013年1月于陆军总医院门诊体检的早期动脉硬化伴血管内皮功能障碍的男性患者167例。按血脂水平分为3组，低密度脂蛋白胆固醇（LDL-C）≥3.4 mmol/L归入辛伐他汀40 mg组（57例，辛伐他汀40 mg/d，阿司匹林片100 mg/d，12个月）；2.6 mmol/L≤LDL-C＜3.4 mmol/L归入辛伐他汀20 mg组（65例，辛伐他汀20 mg/d，阿司匹林片100 mg/d，12个月）；LDL-C＜2.6 mmol/L归入对照组（45例，未服用辛伐他汀和阿司匹林片）。于用药前及用药12个月后应用彩色多普勒超声诊断仪检测入选者肱动脉血流介导的舒张功能（FMD），颈动脉、腹主动脉、下肢动脉内膜-中层厚度（IMT）、硝酸甘油介导的非内皮依赖性血管舒张功能（NMD）。检测血脂，包括总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、LDL-C。结果与治疗前比较，辛伐他汀40 mg组和辛伐他汀20 mg组治疗后IMT值均降低，而对照组IMT值增加，差异有统计学意义（P均＜0.05）。与治疗前比较，辛伐他汀40 mg组和辛伐他汀20 mg组治疗后LDL-C和TC水平明显降低，差异有统计学意义（P均＜0.05）。与治疗前比较，辛伐他汀40 mg组和辛伐他汀20 mg组治疗后FMD升高，差异有统计学意义（P均＜0.05）。与对照组治疗后比较，辛伐他汀40 mg组和辛伐他汀20 mg组FMD均升高，差异有统计学意义（P均＜0.05）。三组NMD比较，差异无统计学意义（P均＞0.05）。结论辛伐他汀联合阿司匹林可逆转早期动脉硬化伴血管内皮功能障碍患者的动脉粥样硬化，其作用机制与降低TC、TG和LDL-C有一定关系，但无明显的量效关系，可能独立于降脂作用之外，考虑与改善血管内皮细胞功能相关。%Objective To analyze the interventional effect of simvastatin combining aspirin in patients with early atherosclerosis complicated with vascular endothelial dysfunction.Methods The male patients (n=167) were chosen from the Outpatient Department of the Chinese PLA Army General Hospital from Jan. 2011 to Jan. 2013. All patients were divided, according to their blood fat levels, into group 1 (n=57, LDL-C≥3.4 mmol/L, and given 40 mg/d of simvastatin and 100 mg/d of aspirin for 12 m), group 2 (n=65, 2.6 mmol/L≤LDL-C<3.4 mmol/L, and given 20 mg/d of simvastatin and 100 mg/d of aspirin for 12 m), and control group (n=45, LDL-C<2.6 mmol/L and not given simvastatin and aspirin). The brachial artery flow-mediated dilation (FMD), intima-media thickness (IMT) of carotid artery, abdominal aorta and lower limb artery and nitroglycerin-mediated dilatation (NMD) were detected by using color Doppler ultrasonic diagnostic apparatus before and 12 m after medication. The levels of total cholesterol (TC), triglyceride (TG), high-density lipoprotein-cholesterol (HDL-C) and low-density lipoprotein-cholesterol (LDL-C) were detected.Results After treatment, IMT decreased in group 1 and group 2, and increased in control group (allP<0.05). After treatment, the levels of LDL-C and TC decreased significantly in group 1 and group 2 (allP<0.05). The brachial artery FMD increased in group 1 and group 2 after treatment (allP<0.05). Compared with control group, the brachial artery FMD increased in group 1 and group 2 after treatment (allP<0.05). The comparison in NMD showed no statistical significance among 3 groups (allP>0.05).Conclusion Simvastatin combining aspirin can reverse early atherosclerosis in patients with early atherosclerosis complicated with vascular endothelial dysfunction, and its effective mechanism maybe related to the decreases of TC, TG and LDL-C but there is no significant dose-effect relationship. The effect maybe independent of lipid-lowering effect, which can be considered to be related to the improvement of vascular endothelial function.