林晨志+黃雅玲

[摘要] 目的 探討葉酸片聯(lián)合阿托伐他汀鈣片能否對(duì)延緩高同型半胱氨酸血癥（HCY）患者頸總動(dòng)脈內(nèi)膜中層增厚產(chǎn)生協(xié)同療效。 方法 選取高HCY患者90例，隨機(jī)分為三組，每組30例。聯(lián)合組給予葉酸片和阿托伐他汀鈣片治療，他汀組給予阿托伐他汀鈣片治療，葉酸組給予葉酸片治療。觀察三組在治療前后不同時(shí)間點(diǎn)上，頸總動(dòng)脈內(nèi)膜中層厚度（IMT）、血漿HCY、血總膽固醇（TC）、低密度脂蛋白膽固醇（LDL）、甘油三酯（TG）以及超敏C反應(yīng)蛋白（hsCRP）的變化情況。 結(jié)果 在治療后的各觀察時(shí)間點(diǎn)上組間比較，聯(lián)合組的血漿HCY水平較葉酸組，均無(wú)明顯降低（P>0.05）；聯(lián)合組的血TC、LDL、TG水平較他汀組，均無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05）。在治療后24個(gè)月觀察時(shí)間點(diǎn)上組間比較：聯(lián)合組的IMT小于他汀組（P<0.05），聯(lián)合組的IMT小于葉酸組（P<0.05）。 結(jié)論 葉酸聯(lián)合阿托伐他汀鈣片能明顯降低高同型半胱氨酸血癥患者血同型半胱氨酸水平和血脂水平，聯(lián)合治療減少頸總動(dòng)脈內(nèi)膜中層厚度的遠(yuǎn)期效果更顯著，更有利于延緩動(dòng)脈粥樣硬化。

[關(guān)鍵詞] 葉酸；阿托伐他汀鈣；同型半胱氨酸；頸動(dòng)脈；中層內(nèi)膜厚度

[中圖分類(lèi)號(hào)] R543.4 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 2095-0616（2017）06-11-05

[Abstract] Objective To study the synergistic effect of folic acid tablets in combination with atorvastatin calcium tablet to common carotid artery intima-media thickness（CCA-IMT） of patients with hyperhomocysteinemia. Methods 90 patients with high HCY were randomly divided into three groups，30 cases in each group.Patients in joint group were treated with folic acid tablets and atorvastatin calcium，patients in statin group were treated with atorvastatin calcium， patients in folic acid group were treated with folic acid tablets.The common carotid artery intima-media thickness （IMT），plasma HCY，blood total cholesterol（TC），low-density lipoprotein cholesterol （LDL），triglycerides （TG） and hypersensitive c-reactive protein （hsCRP） changes of the three groups at different time points before and after treatment were observed. Results After treatment，the comparison of each observation point was as follows：Compared with the folic acid group，there were no significantly decreased on plasma HCY levels of joint group（P>0.05）.Compared with the statin group， there were no significantly decreased on blood TC，LDL，TG level of joint group（P>0.05）.24 months after treatment group，comparison between observation time point was as follows：IMT of joint group was less than that of statin group（P<0.05），the IMT of joint group was less than that of folic acid group（P<0.05）. Conclusion Folic acid tablets in combination with atorvastatin calcium tablet can obviously reduce homocysteine levels in patients with blood homocysteine levels and blood lipid levels.Combination therapy to reduce the forward of the common carotid artery intima-media thickness effect is more prominent，and it is more conducive to postpone sclerosis of arterial congee appearance.

[Key words] Folic acid；Atorvastatin calcium；Homocysteine；Carotid artery；Middle membrane thickness

隨著社會(huì)的發(fā)展，缺血性心臟病及腦血管疾病已成為全球的第一、二位的死亡原因，而缺血性心

臟病及腦血管疾病共同的病理基礎(chǔ)是動(dòng)脈粥樣硬化。動(dòng)脈粥樣硬化形成的病理生理過(guò)程是脂質(zhì)成分（以膽固醇為主）在動(dòng)脈壁的沉積。研究顯示，血清總膽固醇水平與動(dòng)脈粥樣硬化的發(fā)生、發(fā)展密切相關(guān)[1]。高同型半胱氨酸（HCY）血癥可引起血管內(nèi)皮功能損害[2]，其已成為繼高血壓高血脂糖尿病吸煙肥胖等因素之后，動(dòng)脈粥樣硬化的又一獨(dú)立危險(xiǎn)因子[3]。高膽固醇血癥和高同型半胱氨酸血癥疊加將加速全身動(dòng)脈粥樣硬化的發(fā)生及發(fā)展。作為全身動(dòng)脈的組成部分，頸動(dòng)脈粥樣硬化程度對(duì)全身動(dòng)脈病變發(fā)生有著重要的參考價(jià)值，并與心腦血管疾病的發(fā)生有著很強(qiáng)的相關(guān)性[4]，尤其頸動(dòng)脈內(nèi)膜中層厚度（IMT）是反映動(dòng)脈硬化的敏感特異性指標(biāo)。頸動(dòng)脈IMT能夠獨(dú)立預(yù)測(cè)心腦血管病事件[5]。因此，頸動(dòng)脈彩超作為一種無(wú)創(chuàng)性的檢查，適用于檢測(cè)頸動(dòng)脈IMT，而頸總動(dòng)脈IMT由于容易獲得并且可重復(fù)性高，臨床上常用的觀察指標(biāo)。通過(guò)測(cè)量治療前后頸總動(dòng)脈IMT變化，判定治療效果。本研究旨在通過(guò)觀察高HCY患者治療前后血漿HCY、血脂水平和頸總動(dòng)脈IMT的變化，了解葉酸片聯(lián)合阿托伐他汀鈣片能否對(duì)延緩或逆轉(zhuǎn)高HCY患者頸總動(dòng)脈IMT抗動(dòng)脈粥樣硬化產(chǎn)生協(xié)同療效?，F(xiàn)報(bào)道如下。