Kang Min-Kyu, Kim Chan Joon, Choo Eun-Ho, Han Eun Ji, Hwang Byung-Hee, Kim Jin-Jin, Kim Sung Hoon, O Joo Hyun, Chang Kiyuk
Cardiology Division, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Cardiology Division, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijoenbu-si, Gyeonggi-do, Republic of Korea.
Int J Cardiovasc Imaging. 2019 Sep;35(9):1745-1753. doi: 10.1007/s10554-019-01584-y. Epub 2019 Jul 16.
No data exist whether statins have robust anti-inflammatory effects of atherosclerotic plaques primarily during the early treatment period or continuously throughout use. This prospective three time point F-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) study of the carotid artery assessed anti-inflammatory effects of statin during the early treatment period (initiation to 3 months) and late treatment period (3 months to 1 year) and their correlation with lipid and inflammatory profile changes during a year of therapy. Nine statin-naïve stable angina patients with inflammatory carotid plaques received 20 mg/day atorvastatin after undergoing initial F-FDG PET/CT scanning of carotid arteries and ascending thoracic aorta, and then completed serial F-FDG PET/CT imaging at 3 and 12 months whose data were analyzed. The primary outcome was the inter-scan percent change in target-to-background ratio (ΔTBR) within the index vessel. At 3 months of atorvastatin treatment, mean serum low-density lipoprotein cholesterol (LDL-C) level decreased by 36.4% to < 70 mg/dL (p = 0.001) and mean serum high-density lipoprotein cholesterol level increased to > 40 mg/dL (p = 0.041), with both maintained with no further reduction up to 1 year (p = 0.516 and 0.715, respectively) while mean serum high sensitivity C-reactive protein level only numerically decreased (p = 0.093). The index vessel ΔTBR showed continuous plaque inflammation reduction over 1 year, by 4.4% (p = 0.015) from the initiation to 3rd months and 6.2% (p = 0.009) from 3rd months to 1 year, respectively, without correlation with lipid profile changes. The ΔTBR of the bilateral carotid arteries and ascending aorta also continuously decreased from 3 months to 1 year. Three time point F-FDG PET/CT imaging demonstrates that statin's anti-inflammatory effect continues throughout its use up to 1 year, even though yielding stable below-target plasma LDL-C levels at 3 months.
目前尚无数据表明他汀类药物是主要在治疗初期还是在整个用药过程中对动脉粥样硬化斑块具有强大的抗炎作用。这项针对颈动脉的前瞻性三个时间点的氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（F-FDG PET/CT）研究评估了他汀类药物在治疗初期（开始至3个月）和治疗后期（3个月至1年）的抗炎作用，以及它们与一年治疗期间血脂和炎症指标变化的相关性。9例患有炎症性颈动脉斑块的初治稳定型心绞痛患者在接受颈动脉和升主动脉的初始F-FDG PET/CT扫描后，接受20mg/天的阿托伐他汀治疗，然后在3个月和12个月完成系列F-FDG PET/CT成像，并对数据进行分析。主要结局是靶血管与本底比值（ΔTBR）的扫描间百分比变化。在阿托伐他汀治疗3个月时，平均血清低密度脂蛋白胆固醇（LDL-C）水平下降36.4%至<70mg/dL（p=0.001），平均血清高密度脂蛋白胆固醇水平升至>40mg/dL（p=0.041），两者在1年内均保持稳定且无进一步下降（分别为p=0.516和0.715），而平均血清高敏C反应蛋白水平仅略有下降（p=0.093）。靶血管ΔTBR显示在1年内斑块炎症持续减轻，从开始至3个月降低4.
