【作者】 徐杰；

【导师】 张金盈；

【作者基本信息】 郑州大学 ， 心血管内科， 2012， 硕士

【摘要】 背景动脉粥样硬化是由于血脂逐渐沉积在动脉内膜,引起平滑肌细胞的生长和结缔组织的增生,从而促进内膜灶性纤维性增厚,形成粥样斑块,导致动脉壁变硬,管腔狭窄,是心脑血管疾病,如高血压、冠心病、脑梗死等的独立危险因素。颈动脉粥样硬化是动脉粥样化病理改变发生在颈动脉处(单侧或双侧),是临床工作中判断全身动脉粥样硬化的缩影,可以了解心脑血管疾病存在的可能,对判断冠状动脉粥样硬化的程度有重要的意义。颈动脉粥样硬化症的发病有多种危险因素,包括年龄、性别、高血压、吸烟、糖尿病、高脂血症等。目前研究表明颈动脉粥样硬化症的治疗要求在严格控制各种危险因素的基础上联合使用药物治疗。他汀类药物是经典的甲基戊二酰辅酶A (HMG-CoA)还原酶抑制剂,除了降低胆固醇外,还能改善血管内皮功能障碍、调节血管平滑肌细胞的增殖和凋亡等。阿托伐他汀是一种疗效确切的降脂药,目前研究表明阿托伐他汀对于颈动脉粥样硬化症的改善有效。但尚未研究使用不同剂量的阿托伐他汀治疗颈动脉粥样硬化症的疗效是否有差别。因此本研究首先要进一步证实颈动脉粥样硬化症的常见独立危险因素,其次要观察不同剂量的阿托伐他汀治疗颈动脉粥样硬化症的疗效是否相同。如果存在差别,其具体的机制可能包括哪些。目前颈动脉粥样硬化症的疗效观察以颈动脉粥样硬化斑块水平(面积、直径、厚度)以及颈动脉中层内膜厚度为常见的判定指标。目的1.探讨颈动脉粥样硬化症常见的独立危险因素。2.比较不同剂量的阿托伐他汀对颈动脉粥样硬化斑块大小(面积、直径、厚度)、颈动脉中层内膜厚度的影响是否有差别。3.比较不同剂量的阿托伐他汀对颈动脉粥样硬化患者的血浆标志物TC、 TG、LDL-C、hs-CRP、NTproBNP、MCP-1水平的影响是否有差别。方法1.入选颈动脉粥样硬化症患者组142例,健康正常对照组142例,比较两组间的BMI、TC、TG、LDL-C水平,吸烟史、饮酒史及糖尿病史等等是否存在统计学差异。2.将142例颈动脉粥样硬化症患者分为五个亚组,每天分别给予10mg、20mg、40mg、60mg、80mg的的阿托伐他汀治疗,连续8月。分别测定其治疗前后的颈动脉粥样硬化斑块直径、厚度、面积、斑块类型、颈动脉IMT,以及治疗前后的hs-CRP、NTproBNP、MCP-1、TC、TG、LDL-C水平。结果1.颈动脉粥样硬化患者组的BMI、TG、TC、LDL-C水平均高于健康对照组,吸烟史、饮酒史人数均多于对照组,且差异均具有统计学意义(P<0.05)。2.不同剂量的阿托伐他汀治疗后减小颈动脉粥样硬化斑块的大小(面积、直径、厚度)以及颈动脉IMT的程度不同,其中高剂量组使其缩小的程度也越大,且差异均具有统计学意义(P<0.05)。3.不同剂量的阿托伐他汀治疗前后的血浆标志物包括TC、TG、LDL-C、 hs-CPP、NTproBNP、MCP-1水平均降低,但降低的程度不同,其中高剂量组其降低的程度更大,且差异均具有统计学意义(P<0.05)。结论1.颈动脉粥样硬化症患者BMI、TG、TC、LDL-C水平,以及有吸烟史、饮酒史人数均明显高于健康对照组,证实以上指标是颈动脉粥样硬化症常见的的独立危险因素。2.不同剂量的阿托伐他汀对颈动脉粥样硬化斑块和颈动脉中层内膜厚度缩减程度不同,高剂量对颈动脉斑块和颈动脉中层内膜厚度具有较好的缩减作用。3.不同剂量的阿托伐他汀对颈动脉粥样硬化症患者的血浆指标,包括TC、TG、LDL-C、BNP、hs-CRP、MCP-1降低的程度不同,高剂量对各指标的降低程度较明显。更多还原

【Abstract】 BackgroundAtherosclerosis is due to the blood fat deposition in the carotid endometrial causes the growth of smooth muscle cells, the connective tissue proliferation,the focal intimal fibrous thickening and the formation of atherosclerotic plaque, and eventually causes harden artery walls and luminal stenosis. Lots of researches show that atherosclerosis contributes to couples of cardiovascular diseases such as hypertension, coronary heart disease, cerebral infarction and so on. Carotid arteries atherosclerosis represents a type of disease whose porridge-like pathological changes happening at the site of carotid (unilateral or bilateral). Carotid arteries atherosclerosis is the epitome of systemic atherosclerosis, can learn the occurrence of cardio cerebrovascular diseases, and has important significance on the judgement of coronary atherosclerosis extent. The pathogenesis of carotid arteries atherosclerosis have a variety of risk factors, such as age, sex, hypertension, smoking, diabetes, hyperlipidemia, and so on. Current researches show that the treatments of carotid arteries atherosclerosis require combining the medication on the basis of controlling all kinds of risk factors strictly.Statin is classic methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors with main effect to lower cholesterol. Additionally, it has show a variety of other effects, such as improving endothelial dysfunction and regulating the proliferation and apoptosis of vascular smooth muscle cells, except the lipid lowering effect, atorvastatin is also reported to act the anti-carotid atherosclerotic plaques effectively. Atorvastatin is a kind of definite therapeutic cholesterol-lowering drug. The present studies show that atorvastatin is valid for carotid arteries atherosclerosis improvement. Whether the different dose of atorvastation may influence the protective effect of carotid arteries atherosclerosis improvement still needs to be studied. So we need research the common independent risk factors of carotid arteries atherosclerosis firstly and observe whether the different doses of atorvastatin have the same effect in the treatment of carotid arteries atherosclerosis secondly. What specific mechanism may be included if there are differences. Meanwhile, the area, diameter, thickness of plaque and the intima media thickness (IMT) of the carotid arteries are used to evaluate the treatment effectiveness on carotid arteries atherosclerosis in clinic.Objective1. To investigate the common independent risk factors of carotid arteries atherosclerosis.2. To observe whether the different doses of atorvastatin have the different effects in the influence of the area, diameter, thickness of plaque and the intima media thickness (IMT) of the carotid arteries.3. To observe whether the different doses of atorvastatin have the different effects in the influence of Plasma markers, such as TC, TG, LDL-C, hs-CRP, NTproBNP, IL-6, MCP-1of carotid arteries atherosclerosis patients.Methods1.142patients with carotid arteries atherosclerosis, and142in control group were chosen. Then the levels of BMI, TC, TG, LDL-C, smoking history, drinking history and history of diabetes were compared between the two groups.2. The142carotid arteries atherosclerosis patients were randomly divided into five groups and were given10mg,20mg,40mg,60mg,80mg atorvastatin every day separately for consecutively8months. Then the plaque morphology, range, size, hardness, carotid intima-media thickness (IMT) before and after treatment were recorded. The levels of TC, TG, LDL-C,hs-CRP, NT-proBNP, MCP-1, and after treatment were also recorded.Results1. The levels of BMI, TG, TC, LDL-C and the number of smoking history or drinking history with carotid arteries atherosclerosis patients were significantly higher than those of control group.2. The different doses of atorvastatin have the different effects in the influence of the area, diameter, thickness of plaque and the intima media thickness (IMT) of the carotid arteries. The higher dose groups make the narrow degrees of plaques greater. And the differences were statistically significant (P<0.05)3. The different doses of atorvastatin have the different effects in the influence of Plasma markers, such as TC, TG, LDL-C, hs-CRP,NTproBNP, MCP-1. The higher dose groups make the lowering degrees of them greater. And the differences were statistically significant (P<0.05)Conclusions1. The levels of BMI, TG, TC, LDL-C and the numbers of smoking history or drinking history with carotid arteries atherosclerosis patients were significantly higher than those of control group. And the results confirm that the indicators all the above were the common independent risk factors of carotid arteries atherosclerosis.2. The different doses of atorvastatin have the different reduced effects in the influence of the area, diameter, thickness of plaque and the intima media thickness (IMT) of the carotid arteries. The higher dose groups make the reducing of plaques and intima media thickness greater.3. The different doses of atorvastatin have the different reduced effects in the influence of Plasma markers, such as TC, TG, LDL-C, hs-CRP, NTproBNP, MCP-1. The higher dose groups make the lowering degrees of them greater.更多还原