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目的观察不同剂量阿托伐他汀对冠心病患者血脂及颈动脉粥样硬化斑块的影响。方法将冠心病合并颈动脉粥样硬化斑块患者76例按就诊号随机分为观察组和对照组,各38例,观察组予阿托伐他汀40 mg,对照组予阿托伐他汀20 mg,治疗10个月后,检测患者的总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、超敏C反应蛋白(hs-CRP)、B型脑钠肽前体(BNP)及单核细胞趋化蛋白-1(MCP-1)的水平,并采用彩色多普勒超声仪对患者进行颈动脉超声检查。结果治疗后2组患者血脂及血清炎性因子水平均较治疗前显著改善,且观察组优于对照组,差异均有统计学意义(P<0.05)。治疗后,2组患者颈动脉粥样硬化斑块直径、厚度、面积均改善(P<0.05),观察组IMT值降低(P<0.05)。对照组治疗前后IMT无明显变化(P>0.05)。观察组患者治疗后斑块厚度、面积、IMT值优于对照组,差异有统计学意义(P<0.05)。2组斑块直径比较差异无统计学意义(P>0.05)。治疗后,2组患者软斑数有显著降低(P<0.05),且观察组患者软斑数低于对照组(P<0.05);治疗后,2组混合斑数均显著上升(P<0.05),但2组间比较差异无统计学意义(P>0.05);2组患者治疗前后硬斑数变化比较差异无统计学意义(P>0.05)。结论 40 mg/d阿托伐他汀能更有效改善冠心病患者的血脂水平,对其具有更好的保护作用。
Objective To observe the effects of different doses of atorvastatin on blood lipid and carotid atherosclerotic plaques in patients with coronary heart disease. Methods 76 patients with coronary heart disease and carotid atherosclerosis plaque were randomly divided into observation group and control group according to the visit number, 38 cases in each group. The observation group received atorvastatin 40 mg and the control group received atorvastatin 20 mg (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), high sensitivity C-reactive protein (hs-CRP), B-type natriuretic peptide (BNP) and monocyte chemoattractant protein-1 (MCP-1) were measured. Carotid ultrasonography was performed on patients with color Doppler ultrasound. Results After treatment, the levels of serum lipids and serum inflammatory factors in both groups were significantly improved compared with that before treatment, and the observation group was superior to the control group with statistical significance (P <0.05). After treatment, the diameter, thickness and area of carotid atherosclerotic plaque were improved in both groups (P <0.05), and the IMT value in the observation group was decreased (P <0.05). There was no significant change in IMT before and after treatment in control group (P> 0.05). The thickness, area and IMT of the observation group were better than those of the control group after treatment, the difference was statistically significant (P <0.05). There was no significant difference in plaque diameter between the two groups (P> 0.05). After treatment, the number of soft spots in both groups was significantly decreased (P <0.05), and the number of soft spots in the observation group was lower than that in the control group (P <0.05). After treatment, the mixed spots were significantly increased in both groups (P <0.05 ), But there was no significant difference between the two groups (P> 0.05). There was no significant difference in the number of hard spots between the two groups before and after treatment (P> 0.05). Conclusion Atorvastatin 40 mg / d can effectively improve blood lipid levels in patients with coronary heart disease, which has a better protective effect.