目的 观察他汀类药物对老年高血压患者颈动脉内膜中层厚度(CIMT)及Ⅱ A型分泌型磷脂酶A2(sPLA2 Ⅱ A)的影响.方法 选取2010年1月至2013年6月厦门大学附属第一医院住院和门诊≥65岁的老年高血压患者101例,采用随机数字表法将患者分为阿托伐他汀组(52例)和瑞舒伐他汀组(49例),分别接受阿托伐他汀20 mg/d及瑞舒伐他汀10 mg/d为期12个月的治疗.采用彩色多普勒超声测定CIMT,采用酶联免疫吸附法测定血清sPLA2 Ⅱ A水平.对比2组患者用药前后血脂、CIMT及sPLA2 Ⅱ A水平.结果 治疗12个月后,2组患者总胆固醇、低密度脂蛋白胆固醇(LDL-C)及三酰甘油较治疗前降低(均P ＜0.05),高密度脂蛋白胆固醇变化差异无统计学意义(P＞0.05).治疗后瑞舒伐他汀组LDL-C水平低于阿托伐他汀组[(1.94±0.51) mmol/L比(2.11 ±0.25)mmol/L,P＜0.05].2组患者最大CIMT较治疗前变薄[阿托伐他汀组:(1.16 ±0.68)mm比(1.27 ±0.75) mm;瑞舒伐他汀组:(1.18 ±0.59)mm比(1.31 ±0.62) mm,P＜0.05],血清sPLA2 Ⅱ A水平较治疗前降低[阿托伐他汀组:(3.1 ±0.6) μg/L比(4.4±1.0) μg/L;瑞舒伐他汀组:(3.2±0.8)μg/L比(4.4±1.0) μg/L](均P＜0.05).结论 他汀类药物可以降低血清sPLA2ⅡA水平,对老年高血压患者颈动脉粥样硬化有保护作用.%Objective To observe the effects of statins on carotidintima-media thickness (CIMT) and secretory type Ⅱ A phospholipase A2 (sPLA2 Ⅱ A) in elderly patients with hypertension.Methods Totally 101 elderly patients (≥65 years old) from January 2010 to June 2013 were randomly divided into atorvastatin group (52 cases) receiving atorvastatin 20 mg/d for 12 months,and rosuvastatin group (49 cases) receing rosuvastatin 10 mg/d for 12 months.The CIMT was measured by color doppler ultrasound,the level of sPLA2 Ⅱ A in plasma were determined by enzyme linked immunosorbent assay.The of CIMT and sPLA2 Ⅱ A before and after treatment were compared in the two groups.Results The total cholesterol,low-density lipoprotein cholesterol (LDL-C) and triglycerides were significantly reduced compared with those before treatment in atorvastatin group (all P ＜ 0.05),the level of high density lipoprotein cholesterol had no significant change after treatment (P ＞ 0.05).The level of LDL-C was significantly lower in rosuvastatin group than that in atorvastatin group [(1.94 ± 0.51) mmol/L vs (2.11 ±0.25) mmol/L] (P ＜0.05).The maximal CIMT after treatment significantly reduced compared with that before treatment in both atorvastatin group [(1.16 ±0.68) mm vs (1.27 ±0.75) mm] and rosuvastatingroup [(1.18 ±0.59) mm vs (1.31 ±0.62) mm] (P＜0.05).The level of sPLA2 ⅡA was significantly decreased after treatment compared with that before treatment in atorvastatin group [(3.1 ±0.6) μg/L vs (4.4± 1.0) μg/L] and rosuvastatin group [(3.2 ±0.8) μg/L vs (4.4 ± 1.0) μg/L] (P ＜0.05).Conclusion Statins can effectively reduced the level of plasma sPLA2 Ⅱ A and protective function on carotid atherosclerosis in elderly patients with hypertension.
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