阿托伐他汀对高龄患者动脉粥样硬化的影响及安全性研究

摘要

目的 观察长期使用阿托伐他汀对于高龄(≥80岁)患者颈动脉粥样硬化病变的影响及安全性. 方法 61例患者进入研究,给予阿托伐他汀(20mg/d)治疗,随访5年,治疗前后检测颈动脉彩色多普勒超声及血脂、血糖、肝肾功能及肌酸激酶等. 结果 56例患者完成随访,治疗前后比较,低密度脂蛋白胆固醇(LDL-C)显著降低(P＜0.05),而高密度脂蛋白胆固醇(HDL-C)显著升高(P＜0.05),空腹总胆固醇、三酰甘油、血糖、血尿素、肌酐、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、血清总胆红素(STB)、结合胆红素(CB)、肌酸激酶(CK)治疗前后比较,差异无统计学意义(P＞0.05).斑块面积总和显著减少[(0.63±0.41)cm2比(1.07±0.67)cm2,t=2.118,P＜0.05],而斑块回声积分显著增加[(2.67±0.52)分比(1.53±0.44)分,t=2.771,P＜0.05],但内中膜厚度变化差异无统计学意义[(0.11±0.02) cm比(0.12±0.02)cm,t=1.528,P＞0.05]. 结论 阿托伐他汀可以用于高龄(≥80岁)患者,长期治疗后可使动脉粥样硬化斑块缩小而且变成稳定的斑块.%Objective To investigate the effect and safety of long-term use of atorvastatin on carotid atherosclerosis in advanced elderly patients.Methods Totally 61 elderly patients with carotid atherosclerosis were permitted into study.They were treated with atorvastatin (20 mg/d) and followed-up for five years.The carotid atherosclerosis parameter and the serum levels of TC,TG,LDL-C,HDL-C,fasting blood glucose (FBG),ALT,AST,STB,CB,Bun,Cr and creatine kinase (CK) were measured before and 5 years after treatment.Results During fellow-up,2 patients died of severe pneumonia and 1 patient died of operation complications of intestinal obstruction,with mortality rate of 4.9％.2 patients (3.4％) gave up treatment because of muscle-related side-effect.Data was collected in 56 patients achieving study end.There was significant decrease in LDL-C (P＜0.05) and increase in HDL-C (P＜0.05),but there was no change in serum levels of TC,TG,FBG,ALT,AST,STB,CB,BUN,Cr and CK (P＜0.05) after 5 years.The total area of carotid atherosclerosis plaque was reduced [(0.63±0.41)cm2 vs.(1.07±0.67)cm2,P＜0.05] and echo of carotid atherosclerosis plaque was enhanced (2.67±0.52 vs.1.53±0.44,P＜0.01),but carotid intima-media thickness(IMT) appeared no change after five years.Conclusions Atorvastatin is safe in the treatment of advanced elderly patients,it can make carotid atherosclerosis plaque smaller and stable after long-term treatment.