立普妥不同剂量对老年高血压患者血脂和颈动脉内膜—中层厚度的影响

不同剂量阿托伐他汀治疗老年颈动脉粥样斑块增厚疗效观察张林成都市第五人民医院成都市温江区麻市街33号摘要目的研究阿托伐他汀能否改善老年患者颈动脉内膜中层厚度。

方法选取颈动脉粥样斑块增厚患者210例，随机分为三组,治疗一组患者口服阿托伐他汀(立普妥)10mg，Qd，12周；治疗二组患者口服阿托伐他汀(立普妥)20mg，Qd，12周；对照组患者口服阿托伐他汀(阿乐)10mg，Qd，12周。

结果与治疗前比较，治疗12周后的三组颈动脉IMT厚度均有明显改善(每组治疗前后IMT厚度值比较, P＜0.05),且治疗二组改善IMT厚度水平优于治疗一组和对照组 (P＜0．05)，治疗一组、对照组颈动脉改善IMT无统计学差异;三组患者治疗后TC、TG、LDL-C水平均有明显降低(P均＜0.05)。

结论阿托伐他汀能有效改善IMT。

[关键词]阿托伐他汀；颈动脉；内膜增厚；老年人[KEY WORDS] atorvastatin; carotid stenosis; IMT;elderlyDifferent Dosages of Atorvastatin on the IMT of elderly Patients Lin ZHANG我国心血管病现患人数至少2.3亿，每年心血管病死亡约300万人，总死亡每3人中就有1人是心血管病[1]。

但是对动脉粥样硬化的早期检测仍然是一个具有挑战性的研究和发展领域[2]。

颈动脉内膜中层厚度的增厚是动脉粥样硬化进程的指示器[3]。

流行病学和临床研究证据表明胆固醇是动脉硬化发展的关键元素，LDL-C对动脉硬化发展有非常重要的作用[4]。

针对血清胆固醇水平及冠心病发生率相对较低的东方人群尤其中国人，不同阿托伐他汀剂量的类似研究在较短时间内获得相关结果是可以期待的。

(今年我国老年人冠心病和动脉栓塞发病率逐年上升()引用证实阿托伐他汀能有效降低血清LDL-C,从而延缓动脉硬化),对老年患者,由于需要长期控制血脂,为多大剂量的阿托伐他汀既能有效降低血脂,又能安全通过B超测量IMT是一个相对简单的程序，他的特点是安全、经济、精确和重现性好[5]本研究希望通过观察不同剂量立普妥对IMT增厚及粥样硬化斑块形成患者的治疗效果，即：有效率、达标率、不良反应发生率、安全性、治疗依从性、药物的卫生经济学指标等数据；找出哪种剂量立普妥在IMT增厚及粥样硬化斑块形成患者的治疗中更适合？哪种剂量立普妥能阻止中国人动脉粥样硬化进展甚至逆转动脉粥样硬化或缩小斑块面积？中国人尤其老年患者立普妥强化治疗的剂量与国外有何不同？哪种剂量可作为高危人群的推荐剂量而向临床推广？为临床医生及病人提供更多的循证医学证据，以规范治疗，降低因斑块破裂而导致的心血管事件的发生率。

立普妥对原发性高血压患者正常血脂和颈动脉内膜中层厚度的影响白杨;邓挺【期刊名称】《中国实用医药》【年(卷),期】2015(000)001【摘要】目的：探讨阿托伐他汀钙(立普妥)10 mg/d对无动脉硬化原发性高血压患者正常血脂和颈动脉内膜中层厚度(CaIMT)的影响。

方法102例血脂正常且无动脉硬化的原发性高血压患者,随机分为观察组52例,对照组50例,两组在常规降压治疗的基础上,观察组加用立普妥10 mg/d,分别于治疗前、治疗后6个月测定两组血脂、血压、CaIMT,比较两组变化差异。

结果与治疗前比较,观察组治疗后6个月总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)水平显著下降(P<0.05),高密度脂蛋白胆固醇(HDL-C)水平显著升高(P<0.05),对照组治疗前后血脂无明显变化(P>0.05)。

两组患者血压均较基础值降低,与对照组相比观察组降低程度更为明显(P<0.05)。

观察组CaIMT较治疗前及对照组均有显著降低(P<0.05),对照组CaIMT治疗前后改变不明显(P>0.05)。

结论立普妥10 mg/d治疗无动脉硬化原发性高血压患者能显著改善血脂、降低血压、降低CaIMT,能有效预防原发性高血压患者发生动脉硬化。

%Objective To explore the influence of 10 mg/d of atorvastatin calcium (Lipitor) on essential hypertension without arteriosclerosis patients’ normal blood lipid and carotid intima-media thickness (CaIMT). Methods A total of 102 cases of essential hypertension with normal blood lipid and without arteriosclerosis were randomly divided into observation groupwith 52 cases and control group with 50 cases. On the basis ofconventional antihypertensive therapy, the observation group received 10 mg/d of Lipitor. Blood lipid, blood pressure and CaIMT were detected before and in 6 months after treatment. The differences of the two groups were compared.Results Compared with the indexes before treatment, the levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) in 6 months after treatment of the observation group was decreased (P<0.05), and level of high-density lipoproteincholesterol (HDL-C) was increased (P<0.05). There was no significant difference in the control group before and after treatment (P>0.05). Blood pressure in both groups were lower than the basic value, and the decrease in observation group was more obvious than the control group (P<0.05). The level of CaIMT of the observation group was obviously decreased, compared with the control group and that before treatment (P<0.05). There was no significant difference of CaIMT in the control group before and after treatment (P>0.05).Conclusion 10 mg/d of Lipitor in the treatment of essential hypertension without arteriosclerosis can improve blood lipid, and decrease blood pressure and CaIMT, and it is an effective prevention of arteriosclerosis in essential hypertension.【总页数】3页(P8-10)【作者】白杨;邓挺【作者单位】510120 广州市东升医院;广州市广钢医院【正文语种】中文【相关文献】1.血脂康对血脂正常的高血压患者颈动脉内膜中层厚度的影响 [J], 陈重捷2.银丹心脑通软胶囊联合洛伐他汀对135例原发性高血压患者颈动脉内膜中层厚度及血脂相关危险因素的影响 [J], 袁萍;李娟3.厄贝沙坦氢氯噻嗪对原发性高血压患者血脂水平与颈动脉内膜中层厚度的影响[J], 郭晓玲4.瑞舒伐他汀对血脂正常的无动脉硬化原发性高血压患者颈动脉内膜中层厚度及肱踝脉搏波传导速度的影响 [J], 吴晓春;季乃军;吴少琴;王建军5.他汀类药物联合苯磺酸氨氯地平对血脂异常型原发性高血压患者血压控制及颈动脉内膜中层厚度的影响 [J], 陈惠英; 李奕才; 邓智武因版权原因，仅展示原文概要，查看原文内容请购买。

国产阿托伐他汀对老年人颈动脉内膜中层厚度影响的随机临床对照研究梁晓秋;张林;熊明【期刊名称】《实用老年医学》【年(卷),期】2012(026)001【摘要】目的对比观察国产阿托伐他汀(阿乐)与进口阿托伐他汀(立普妥)对老年人颈动脉内膜中层厚度(IMT)及血脂水平的影响. 方法将符合标准的108例患者随机分为2组,治疗组口服阿乐10 mg/d(n=57),对照组口服立普妥10 mg/d(n=51),疗程24周.观察治疗前、后颈动脉IMT及血脂变化,药物不良反应等.结果 2组药物治疗24周后与治疗前组内比较颈总动脉和双侧颈动脉分叉处IMT有明显改善(P＜0.01),颈内动脉IMT无明显改善(P＞0.05)；2组组间比较IMT则无统计学差异(P ＞0.05).治疗24周后2组血脂低密度脂蛋白胆固醇(LDL-C)、总胆固醇(TC)均明显下降,与治疗前相比有明显统计学差异(P＜0.01),2组间无明显差异(P＞0.05),不良反应发生率2组比较无明显差异(P＞0.05),2组均未发现严重肝肾功受损或肌酶升高. 结论国产阿托伐他汀10 mg/d对改善我国老年人颈动脉IMT厚度、血脂LDL-C、TC水平与进口阿托伐他汀10 mg/d疗效等同,且不良反应小、价格低廉,可作为我国老年人调脂治疗的常规药物.%Objective To explore the effect of domestic atorvastatin and imported atorvastatin on carotid artery inti-ma-media thickness (IMT) and the levels of blood fat in elderly patients. Methods One hundred and eight patients were randomly divided into two groups:treatment group(n=57, receiving domestic atorvastatin therapy for 24 weeks, 10 mg/d) and control group(n = 51, receiving importedatorvastatin therapy for 24 weeks, 10 mg/d). During the next 24 weeks, the changes of carotid IMT and the levels of blood fat after treatment and the adverse reactions were observed. Results There was a significant improvement (P <0. 01) in the common carotid artery and its bifurcation IMT after treatment for 24 weeks, whereas there was no significant difference in the internal carotid artery IMT ( P > 0. 05 ). There was no statistical difference in IMT between the two groups ( P > 0. 05 ) . After treatment, the levels of LDL-C and TC were significantly decreased(P<01) , while there was no statistical difference between the two groups(P >0. 05). And the incidence rate of adverse events between the two groups also had no significant statistical difference ( P > 0. 05 ). No patients showed severe damage of liver function and the increase of creatase. Conclusions Treatment with domestic atorvastatin and imported atorvastatin (10 mg/d) have the same effect on IMT and the level of blood fat. Domestic atorvastatin has a good safety and a lower price,and should be the regular medicine for elderly patients.【总页数】3页(P44-46)【作者】梁晓秋;张林;熊明【作者单位】611130 四川省成都市,成都市第五人民医院功能科;611130 四川省成都市,成都市第五人民医院心内科;611130 四川省成都市,成都市第五人民医院心内科【正文语种】中文【中图分类】R543.5【相关文献】1.阿托伐他汀对高脂血症并颈动脉粥样硬化患者颈动脉内膜中层厚度及炎症标志物的影响 [J], 冯润川;潘华;谢丽圣;宋晓玲;陈富荣2.国产阿托伐他汀治疗原发性高脂血症的疗效和安全性的随机临床对照研究 [J], 李继远3.中国产与进口瑞舒伐他汀治疗对高龄糖尿病伴颈动脉粥样硬化患者颈动脉内膜中层厚度及炎性因子的影响 [J], 邓建松;袁晓冬;刘志高4.阿托伐他汀对高脂血症患者颈动脉内膜中层厚度及脂质代谢的影响 [J], 于文娟5.甲钴胺联合阿托伐他汀治疗H型高血压患者的临床疗效及其对内质网应激标志蛋白和颈动脉内膜中层厚度的影响 [J], 李涛; 李靓; 杨景美因版权原因，仅展示原文概要，查看原文内容请购买。

中西医结合对高脂血症患者颈动脉内-中膜厚度及斑块影响的临床研究郑默【摘要】目的:探讨通心络胶囊联合立普妥、拜阿司匹林对高脂血症患者颈动脉内-中膜厚度及斑块影响的影响.方法:选择80例高脂血症并发颈动脉粥样硬化的患者,随机分为对照组和联合治疗组.对照组在基础治疗的基础上给予立普妥、拜阿司匹林口服,联合治疗组给予立普妥、拜阿司匹林、通心络胶囊口服,疗程6个月.比较两组治疗前后的血脂水平及颈动脉内-中膜厚度(IMT)及斑块情况.结果:治疗后,两组的血TC、LDL-C、TG水平较治疗前均显著降低(P＜0.01),HDL-C均显著上升(P＜0.01),联合治疗组的TC、LDL-C、TG降低程度及HDL-C的升高程度均大于对照组(P＜0.01).治疗前,两组的斑块数量、面积、IMT均无统计学差异(P＞0.05).治疗后,联合治疗组的斑块数量、面积、IMT均显著低于对照组,差异均有统计学意义(P ＜0.01).结论:通心络联合立普妥、拜阿司匹林对高脂血症患者的降脂作用更加显著,其对动脉内-中膜厚度的减少及斑块的消退作用更加确切,可更好的预防心脑血管疾病的发生.%Objective:To investigate the effect of Tongxiuluo capsule combined with Lipitor and Aspirin on intima-media thickness of the common carotid artery and plaque in patients withhyperlipidemia.Methods:80 cases of hyperlipidemia concurrent carotid atherosclerosis patients were randomly divided into control group and combined treatment group.The control group was treated with Lipitor and Aspirin on the basis of the basic treatment,while the combined treatment group was given Lipitor,Aspirin and Tongxinluo capsule,and the course was six months.Lipid levels,carotid artery and intima-media thickness (IMT)were compared before and after the treatment.Results:After the treatment,the blood TC,LDL-C,TG levels in two groups decreased(P ＜0.01) and HDL-C increased significantly (P ＜0.01) signifcantly and aificantly the extent of changes in combined treatment group was greater than that in the control group (P ＜ 0.01).Before treatment,there was no significant difference on the patches number,area,IMT in the two groups (P ＞0.05).After treatment,the number of patches,area and IMT were all lower in the combined treatment group than those in the control group,the differences were statistically significant (P ＜ 0.01).Conclusion:Tongxinluo capsule combined with Lipitor and Aspirin can alleviate the bloodlipid,intima-media thickness of the common carotid artery and plaque obviously,which can better prevent the cardiovascular and cerebrovascular.【期刊名称】《中医药学报》【年(卷),期】2013(041)003【总页数】3页(P112-114)【关键词】通心络;高脂血症;立普妥【作者】郑默【作者单位】浙江省永嘉县中医院神经内科,浙江永嘉325102【正文语种】中文【中图分类】R259随着经济发展和饮食结构的变化，高脂血症在人群中的发病率逐年提高，而高血脂的直接损害为全身的动脉粥样硬化，进一步导致脑梗死、心肌梗死等严重疾病的发生，因此，有效降低患者血脂水平，稳定动脉粥样硬化斑块，可降低心脑血管病的发病率。

不同剂量阿托伐他汀对老年高血压患者血脂、颈动脉粥样硬化的临床研究王瑾【摘要】Objective To investigate the influence of different doses of atorvastatin in treatment of blood lipid and carotid atherosclerosis in elderly patients with hypertension.Methods 140 elderly patients with hypertension were selected in hospital from January 2013 to January 2015, who were divided into two groups by random number table methods. 70 patients treated with atorvastatin 10 mg/d as control group. 70 patients treated wuth atorvastatin 40 mg/d as observation group. Course of treatment is 1 year. Improvement of blood pressure,blood lipid,carotid atherosclerosis were compared between two groups.Results Compared with before treatment,diastolic blood pressure, systolic blood pressure,total cholesterol,triglyceride,low density lipoprotein cholesterol,intima media thickness,intima plaque area, vulnerable plaque detection rate decreased after treatment in two groups(P<0.05). While high density lipoprotein cholesterol increased after treatment in two groups(P<0.05). Diastolic blood pressure,systolic blood pressure,total cholesterol,triglyceride,low density lipoprotein cholesterol,intima media thickness,intima plaque area,vulnerable plaque detection rate after treatment in observation group were lower than control group(P<0.05) . While high density lipoprotein cholesterol after treatment in observation group were higher than control group(P<0.05).Conclusion High doseatorvastatin can significantly improve blood pressure,blood lipid,carotid hypertension in elderly patients with hypertension.%目的：探讨不同剂量阿托伐他汀对老年高血压患者血脂、颈动脉粥样硬化的影响。

阿托伐他汀对老年人颈动脉粥样斑块的临床观察［摘要］目的观察阿托伐他汀对老年人颈动脉粥样斑块的影响。

方法对45例颈动脉斑块的老年患者给予阿托伐他汀(立普妥)10mg,每日一次，治疗1年，每6个月检测患者血脂水平，12个月时用高频彩色多普勒超声观察患者颈动脉斑块大小及内中层膜厚度的变化。

结果阿托伐他汀治疗1年后，CT、LDL- C、TG均下降(Ｐ＜0.05)，HDL-C升高，(Ｐ＜0.05)，颈动脉斑块缩小及内中层膜厚度减少。

结论阿托伐他汀具有稳定及消退颈动脉粥样斑块的作用。

［关键词］老年人；颈动脉粥样斑块；阿托伐他汀；血脂文献标识码：B颈动脉粥样斑块是诸多心脑血管疾病重要的危险因素之一。

本研究旨在观察降脂药阿托伐他汀对老年人颈动脉粥样斑块及血脂水平的影响。

1 资料与方法1.1 临床资料：从2006年6月至2007年6月期间，在我科门诊和住院经颈动脉彩色多普勒超声检查，有颈动脉粥样斑块形成的患者45例，其中男38例，女7例，平均(73.2±7.4)岁。

1.2 治疗方法：所有患者在基础药物(包括硝酸脂类、钙离子拮抗剂、β受体阻滞剂、ACE I类、抗血小板制剂等)治疗的同时，均服用阿托伐他汀钙片(立普妥，辉瑞制药有限公司)10 mg，每日1次，共服用12个月。

服药前、服药6个月及12个月时分别检测血常规、血脂、肝、肾功能，服药前及服药12个月时行颈动脉超声检查。

1.3 颈动脉超声：选用美国acuson SEQUOIA 512高频彩色多普勒超声诊断仪，探头频率7 .5MHZ，所有检查均由高年资技师专人操作。

患者采取仰卧位，头部偏向检查对侧，分别行纵切、横切扫描，检查部位包括两侧颈总动脉窦部、颈内动脉起始部，观察动脉内中层膜厚度及斑块大小形态，分别测量斑块最大长径及斑块最大厚度，测量值取3个心动周期的平均值。

1.4 统计方法：采用SPSS11.0软件包进行方差分析，计量资料数据以x－±s 表示。