他汀类药物对老年冠心病患者冠状动脉粥样硬化斑块的影响

目的评价他汀类药物对轻度胆固醇升高的老年冠心病患者冠状动脉粥样硬化斑块的影响。方法将LDL-C为2.6~3.6 mmol/L的57例冠心病患者分为>65岁组(Ⅰ组,30例)和≤65岁组(Ⅱ组,27例)。每例患者选取一处狭窄50%~70%的斑块为靶病变。分别于治疗前和治疗后12个月行冠状动脉造影(CAG)和靶病变的血管内超声(IVUS),比较血管、管腔和斑块体积,并观察斑块钙化情况。结果Ⅰ组和Ⅱ组患者12个月后LDL-C平均降至2.39 mmol/L和2.23 mmol/L,较基线下降32.1%和33.2%。两组患者血管、管腔和斑块体积在治疗前无显著差异。治疗12个月后,Ⅰ组血管、管腔和斑块体积无显著变化,Ⅱ组血管体积无变化;管腔体积由(68.8±14.4)mm3增加至(83.6±22.5)mm3(P<0.05),斑块体积由(80.1±18.6)mm3缩小至(69.9±21.7)mm3(P<0.05)。钙化斑块比例Ⅰ组明显高于Ⅱ组(56.7%vs25.9%,P<0.05)。结论他汀类药物可以阻止LDL-C轻度升高的老年冠心病患者冠状动脉斑块的进展。

The effects of statins on atherosclerotic plaque of coronary artery in old patients with coronary heart disease

Objective To evaluate the effects of statins on atherosclerotic plaque of coronary artery in old coronary heart disease patients with mild elevation of LDL-C.Methods Fifty-seven coronary heart disease patients were divided into two groups,>65 years old group and ≤65 years old group.One 50%-70% stenosis plaque was selected as target plaque in each patient.Coronary artery angiography(CAG) and target plaque intravascular ultrasound were performed before treatment and 12 months after treatment to compare the plaque volume,lumen volume,vascular volume and calcification of plaque.Results After 12 months,LDL-C in >65 years old group and ≤65 years old group decreased to 2.39 mmol/L and 2.23 mmol/L,i.e.,decreased by 32.1% and 33.2% of the baseline values respectively.In >65 years old group,the plaque volume,lumen volume and vascular volume were unchanged,while in≤65 years old group,the plaque volume decreased from(80.1±18.6) mm3 to(69.9±21.7) mm3(P<0.05),the lumen volume increased from(68.8±14.4) mm3 to(83.6±22.5) mm3(P<0.05),and the vascular volume was unchanged.There were more calcific plaques in >65 years old group than in ≤65 years old group.Conclusion Statin therapy can halt the development of atherosclerotic plaque of coronary artery in old coronary heart disease patients with mild elevation of LDL-C,but the same therapy can make the plaque regress in ≤65 years old group.