他汀类药物对轻度胆固醇升高2型糖尿病患者冠状动脉粥样硬化斑块和重构的影响

目的 评价他汀类药物对轻度胆固醇升高合并糖尿病的冠心病患者冠状动脉粥样硬化斑块和重构的影响.方法 将2003年4月至2007年4月住院的78例合并2型糖尿病的稳定性心绞痛患者分为2组:他汀类药物治疗组(他汀组)40例;非他汀类药物治疗组(非他汀组)38例.入组时,两组患者低密度脂蛋白胆固醇(LDL-C)为2.6～3.6 mmol/L.每例患者选取1处狭窄为50%～70%的病变为靶病变.入组时和12个月后分别行冠状动脉造影(CAG)和靶病变以及参考段的血管内超声(IVUS),比较治疗前后斑块体积、管腔体积、血管体积和冠状动脉的重构指数(RI).结果 他汀组12个月后,平均LDL-C由(3.52±0.56)mmol/L降至(2.41±0.33)mmol/L(P<0.05),较入组时下降31.5%;非他汀组平均LDL-C较入组时差异无统计学意义[(3.50±0.49)mmol/L比(3.55±0.70)mmol/L,P>0.05].血管体积、管腔体积和斑块体积在入组时两组差异无统计学意义.与入组时比较,12个月后非他汀组斑块体积显著增加19.7%[(76.1±13.0)mm3比(95.0 ±21.9)mm3,P<0.05],血管体积差异无统计学意义,管腔体积由(65.0±10.9)mm3减少至(45.4±6.6)mm3,P<0.05.他汀组的斑块体积增加10.1%[(79.5±15.2)mm3比(87.5±17.9)mm3,P<0.05]、血管体积增加7.0%[(148.2±40.9)mm3比(158.5 ±53.1)mm3,P>0.05]、管腔体积无明显变化.非他汀组治疗前后RI差异无统计学意义(0.93±0.08比0.92±0.09,P>0.05),而在他汀组RI由0.91±0.08增加至0.95±0.10(P<0.05).结论 他汀类药物可以延缓LDL-C轻度升高合并糖尿病的冠心病患者冠状动脉斑块的进展,且可使病变部位血管体积增大、负性重构减轻,甚至可以使部分冠状动脉重构类型发生变化.

Effects of statins on coronary atherosclerotic plaque in patients with coronary heart disease and type 2 diabetes with mild elevated LDL-C

Objective To evaluate the effects of statins on coronary atherosclerotic plaque in patients with stable angina pectoris and type 2 diabetes with mild elevated low density lipoprotein-cholesterol (LDL-C).Methods Seventy-eight patients with stable angina pectoris and type 2 diabetes mellitus and mild elevated LDL-C were treated with(n=40)or without(n=38)statins for 12 months.Coronary artery angiography(CAG)and intravascular ultrasound(IVUS)were performed at baseline and after 12 months on lesion and reference segment to compare the plaque volume,lumen volume,vascular volume and remodeling index wag calculated as vascular volume index(VVI)at lesion divided by VVI at reference segment.One coronary lesion with 50%-70%stenosis was selected as target plaque in each patienL Results Baseline clinical and angiographic data were comparable between the two groups.After 12 months.LDL-C decreased 31.5%in statin group and remained unchanged in non-statin group.After 12 months,plaque volume was significantly increased[(76.1±13.0)mm3 vs.(95.0±21.9)mm3,P<0.05],lumen volume was significantly decreased[(65.0±10.9)mm3 vs. (45.4±6.6)mm3,P<0.05] and vascular volume remained unchanged in non-statins group;plaque volume was also significantly increased[(79.5±15.2)mm3 vs.(87.5±17.9)mm3,P<0.05]while lumen volume and vascular volume remained unchanged in statin group.Remodeling index(RI)remained unchanged in non-statin group but significantly increased in statin group(0. 91 ±0. 08 vs. 0. 95±0.10,P <0. 05) after 12 months. Conclusion Chronic statin therapy could retard the coronary atherosclerotic progression in patients with stable angina pectoris and type 2 diabetes with mild elevated LDL-C.