Shimojima Masaya, Kawashiri Masa-Aki, Nitta Yutaka, Yoshida Taiji, Katsuda Shouji, Kaku Bunji, Taguchi Tomio, Hasegawa Akira, Konno Tetsuo, Hayashi Kenshi, Yamagishi Masakazu
Am J Cardiovasc Dis. 2012;2(2):84-8. Epub 2012 May 15.
Although intensive lipid lowering by statins can enhance plaque stability, few data exist regarding how early statins change plaque composition and morphology in clinical setting. Therefore, to examine early changes in plaque composition and morphology by intensive lipid lowering with statins, we evaluate coronary plaques from acute coronary syndrome (ACS) before and 3 weeks after lipid lowering by coronary CT angiography. We enrolled 110 patients with suspected ACS and underwent coronary CT. We defined plaque as unstable when CT number of plaque< 50HU and remodeling index (lesion diameter/reference diameter) >1.10. Rosuvastatin (5 mg/day) or atorvastatin (20 mg/day) were introduced to reduce low density lipoprotein cholesterol (LDL-C). Then, CT was again performed by the same condition 3 weeks after lipid lowering therapy. Total 10 patients (8 men, mean age 72.0 years), in whom informed consent regarding serial CT examination was obtained, were analyzed. Among them, 4 patients who denied to have intensive lipid lowering were served as controls. In remaining 6 patients, LDL-C reduced from 129.5±26.9 mg/dl to 68.5±11.1 mg/dl after statin treatment. Under these conditions, CT number of the targeted plaque significantly increased from 16.0±15.9 to 50.8±35.0 HU (p<0.05) and remodeling index decreased from 1.22±0.11 to 1.11±0.06 (p<0.05), although these values substantially unchanged in controls. These results demonstrate that MDCT-determined plaque composition as well as volume could be changed within 3 weeks after intensive lipid lowering. This may explain acute effects of statins in treatment of acute coronary syndrome.
尽管他汀类药物强化降脂可增强斑块稳定性，但关于他汀类药物在临床环境中多早能够改变斑块成分和形态的数据却很少。因此，为了通过他汀类药物强化降脂来研究斑块成分和形态的早期变化，我们通过冠状动脉CT血管造影术评估了急性冠状动脉综合征（ACS）患者在降脂治疗前及治疗3周后的冠状动脉斑块情况。我们纳入了110例疑似ACS且接受了冠状动脉CT检查的患者。当斑块CT值<50HU且重构指数（病变直径/参考直径）>1.10时，我们将斑块定义为不稳定斑块。引入瑞舒伐他汀（5毫克/天）或阿托伐他汀（20毫克/天）以降低低密度脂蛋白胆固醇（LDL-C）。然后，在降脂治疗3周后，在相同条件下再次进行CT检查。总共对10例获得了关于连续CT检查知情同意的患者（8名男性，平均年龄72.0岁）进行了分析。其中，4例拒绝进行强化降脂的患者作为对照。在其余6例患者中，他汀类药物治疗后LDL-C从129.5±26.9毫克/分升降至68.5±11.1毫克/分升。在这些条件下，目标斑块的CT值从16.0±15.9显著增加至50.8±35.0HU（p<0.05），重构指数从1.22±0.11降至1.11±0.06（p<0.05），尽管这些值在对照组中基本未变。这些结果表明，强化降脂3周内，MDCT测定的斑块成分以及体积可能会发生变化。这可能解释了他汀类药物在治疗急性冠状动脉综合征中的急性作用。
