目的 观察小剂量阿司匹林联合阿托伐他汀对老年冠心病患者颈动脉粥样硬化的治疗效果.方法 选择江苏省句容市中医院内科2008年1月~2012年12月经彩色多普勒超声检查发现颈动脉粥样硬化斑块的老年冠心病患者126例,其中男性68例,女性58例,年龄60~75岁,平均年龄(64±8.2)岁.随机将所有患者分成A、B两组,每组63例.两组患者性别、年龄、疾病类型及颈动脉超声检查结果、血脂、血糖、心电图检查结果等比较,差异无统计学意义(P均>0.05).在常规治疗基础上,A组给予阿托伐他汀20 mg/d以及阿司匹林100 mg/d,顿服.B组仅给予阿托伐他汀20 m/d,顿服.连续治疗12个月.治疗前和治疗12个月后测定三酰甘油(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高敏C反应蛋白(hs-CRP)水平,彩色多普勒超声测量双侧颈总动脉、颈内动脉和颈外动脉粥样斑块的数量、类型.治疗前和治疗6个月、12个月后测定颈动脉内膜-中层厚度(IMT)及斑块数量.结果 颈部动脉彩色多普勒超声检查,两组患者治疗6个月、12个月后较治疗前IMT和斑块数量均明显减少,差异有统计学意义(P均<0.05).与B组比较,A组治疗12个月后斑块数量明显减少[(30.3±0.06)个vs.(26.4±0.07)个],差异有统计学意义(P均<0.05).治疗12个月后,与B组比较,A组扁平斑和硬斑数量均下降,[(5.04±1.25)个vs.(4.03±1.20)个],[(10.14±1.06)个vs.(8.82±1.18)个],差异有统计学意义(P均<0.05).两组治疗12个月后较治疗前血脂及hs-CRP均下降,差异有统计学意义(P均<0.05).与B组治疗12个月后比较,A组hs-CRP下降[(3.23±1.15)mg/Lvs.(2.92±0.71)mg/L],差异有统计学意义(P均<0.05).结论 小剂量阿司匹林联合阿托伐他汀治疗改善老年冠心病患者颈动脉粥样硬化程度、血脂及hs-CRP效果优于阿托伐他汀单药治疗.
Objective To observe the curative effect of low-dose aspirin combining atorvastatin on carotid atherosclerosis in elderly patients with coronary heart disease (CHD).Methods The elderly patients with CHD (n=126, male 68, female 58, aged from 60 to 75 and average age =64±8.2) were chosen from Jan. 2008 to Dec. 2012, and they had carotid atherosclerotic plaques diagnosed by color Doppler ultrasonic examination. All patients were randomly divided into group A and group B (eachn=63). The difference in sex, age, disease type, Doppler outcome, blood fat, blood sugar and ECG results had no statistical significance between 2 groups (all P>0.05). Based on routine treatment, group A was orally given atorvastatin (20 mg/d) and aspirin (100 mg/d), and group B, only atorvastatin (20 mg/d) for 12 m. The levels of triglyceride (TG), total cholesterol (TC), low-density lipoprotein-cholesterol (LDL-C) and high-sensitivity C-reactive protein (hs-CRP) were detected before and 12 m after treatment. The quantity and types of atherosclerotic plaques were detected by using color Doppler ultrasonic diagnostic apparatus in bilateral common carotid artery (CCA), internal carotid artery (ICA) and external carotid artery (ECA). The changes of carotid artery intima-media thickness (CA-IMT) were detected before and 6 m and 12 m after treatment.Results The color Doppler ultrasonic examination showed that IMT and plaque quantity decreased significantly in 2 groups after treatment for 6 m and 12 m (all P<0.05). Compared with group B, plaque quantity decreased significantly in group A after treatment for 12 m [(30.3±0.06)vs. (26.4±0.07), all P<0.05]. The quantity of flat plaques [(5.04±1.25)vs. (4.03±1.20)] and hard plaques [(10.14±1.06)vs. (8.82 ±1.18)] decreased in group A compared with group B after treatment for 12 m (all P<0.05). The levels of blood fat and hs-CRP decreased in 2 groups after treatment for 12 m (all P<0.05). The level of hs-CRP decreased in group A compared with group B [(3.23±1.15) mg/Lvs. (2.92±0.71) mg/L] after treatment for 12 m (all P<0.05).ConclusionLow-dose aspirin combining atorvastatin has better curative effect than only atorvastatin in relieving carotid atherosclerosis and recovering blood fat and hs-CPR in elderly patients with CHD.