摘要
目的观察葡萄籽原花青素和阿托伐他汀联合应用对老年患者颈动脉粥样硬化的疗效。方法将存在颈动脉粥样硬化斑块的老年高脂血症患者122例，随机分为单药组63例，给予阿托伐他汀20mg／d；联合用药组59例，给予阿托伐他汀10mg／d和葡萄多酚胶囊400mg／d。治疗前及治疗后3、6、12个月测定患者平均最大颈动脉内中膜厚度（MMCIMT）、斑块积分、斑块性质及血脂和超敏C反应蛋白（hs—CRP）水平的变化。结果治疗3个月后，单药组和联合用药组患者与治疗前比较血清总胆固醇（TC）[（4．9±1．0）比（6．5±0．7）mmol／L、（4．7士0．6）比（6．3±0．6）mmol／L]、三酰甘油（TG）[（2．3±0．5）比（2．94-_0．4）mmol／L、（2．2±0．7）比（3．0士0．4）mmol／L3、低密度脂蛋白胆固醇（LDL-C）[（3．3士0．9）比（4．2±0．7）mmoi／L、（3．1±0．6）比（4．O±O．6）mmol／L]降低（均P〈0．01），且随着治疗时间的延长进一步降低。联合用药组患者治疗3个月后高密度脂蛋白胆固醇（HDL—C）水平较治疗前升高20．2％（P〈O．05）。治疗后两组患者血清hs—CRP水平均下降（均P〈0．05）。单药组治疗3个月MMCIMT较治疗前减小1．3％（P〉0．05），治疗6个月减小3．4％（P〉0．05），12个月减小5．1％（P〈0．05）。联合用药组治疗3个月后MMCIMT较治疗前减小2．0％（P〉O．05），6个月减小5．3％（P〈0．05），12个月减小8．6％（P〈0．01）。12个月组问比较差异有统计学意义（P〈O．01）。单药组治疗3个月斑块积分较治疗前减小6．8％（P〉O．05），治疗6个月减小14．5％（P〉0．05），12个月减小19．2％（P〈O．05）；联合用药组患者治疗3个月斑块积分减少13．1％（P〉O．05），且随着治疗时间的延长，斑块积分进一步降低（6个月下降28．0％，P〈0．05；12个月下降45．0％，P〈0．01）。治疗6个月（P〈0．05），两组12个月联合治疗组斑块积分降低更明显（P〈o．01）；联合用药组较单药组斑块总数和不稳定斑块数减少更明显。结论葡萄籽原花青素与阿托伐他汀联合应用，可加强抗动脉粥样硬化治疗的效果。
Objective To observe the effects of grape seed proanthocyanidin extract （GSPE） combined with atorvastatin on carotid atherosclerosis of the elderly. Methods Consecutivly 122 patient aged（73.2 ± 12.8） years with hypercholesterolemia and diagnosed as asymptomatic carotid artery plaques were randomly assigned to single atorvastatin（20 mg/d） treatment group （n~ 63） and combination treatment （atorvastatin 10 mg/d plus GSPE 400 mg/d） group （n= 59）. Serum total cholesterol （TC）, triglyceride （TG）, low density lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL-C） and high-sensitive C-reactive protein （hs-CRP） levels were detected before treatment and 3, 6, 12 months after treatment. Mean maximum carotid intima-media thickness （CIMT）, plaque score and stability were also assessed by carotid ultrasound. Results After 3 months of treatment, serum levels of TC, TG and LDL-C in both groups were lower than before treatment （all P^0.01）, but no difference was found between the two groups （P^0.05）. HDL-Clevels was enhanced by 20.2~ in combination treatment group after 3 months of treatment （P 0.05）, there was difference after 6 months treatment between two groups （P%0.05）. Serum hs-CRP concentrations were decreased by 1.7 mg/L and 3.6 rag/L, 3.8 mg/L and 6.3 mg/L, 5.9 mg/L and 8.3 mg/L after 3, 6 and 12 months treatment as compared with pretreatment, respectively in the two groups （P^0.05 or P^0.01）. There was difference in hs-CRP levels between groups after 6 and 12 months of treatment （P%0.05 or P〈0.01）. There were MMCIMT reduction by 1.3M and 2.0 ~//00 （P^0.05）, 3.4~//00 and 5.3^（P^0.05 and P%0.05 ）, 5.1~ and 8.6M after 3, 6 and 12 months of treatment（P〈0.05 and P^0.01） in the two groups, with distinct difference after 12 month treatment （P〈O. 01）. The plaque scores were declined by 6.8~ and 13.1~ （both P〉O. 05）, 14.5~ and 28. O^（P〉O. 05 and P〈O. 05）, 19.2~ and 45. O^（P〈O. 05 and P〈O. 01）after 3, 6 and 12 months of treatment while significant difference was found between the two groups after 12 months treatment （P〈O. 05）. Unstable plaque and the total number of plaque was dropped by 8 and 14 in single group, 19 and 28 in combination group, respectively, after 12 months of treatment. Conclusions GSPE combined with atorvastatin may inhibit the development of carotid intima-media thickness, reduce carotid plaque and promote stabilization of carotid ~lanue.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2012年第5期371-375,共5页
Chinese Journal of Geriatrics
基金
国家自然科学基金（30700884,30873145）
山东省科技厅重点项目（2010GGCl0294）
关键词
抗氧化剂
降血脂药
动脉硬化
Antioxidants
Antilipemic agents
Atherosclerosis
