背景:以前的血管内超声(intravasc.lar ultrasound,IVUS)试验证实,他汀治疗可减缓或阻止动脉粥样硬化的进展,但是迄今尚无应用动脉粥样斑块体积百分比(perc.nt atheroma volume,PAV)证实粥样硬化消退的确切证据。PAV是最严格的评价病变进展和消退的IVUS测量指标。目标:评价极高强度他汀治疗是否能逆转IVUS确定的冠状动脉粥样硬化。设计和地点:于美国、加拿大、欧洲和澳大利亚53个社区和3级保健中心进行前瞻性开标盲法终点试验(A Study to Evaluate the Effec. of Rosuvastatin on Intravasc.lar Ultrasound-Derived c.ronary Atheroma Burden,ASTEROID)。应用马达驱动回撤IVUS评价基线和治疗24个月时冠状动脉粥样斑块负荷。每对基线和随访IVUS测量结果均进行盲法分析。病例:从2002年11月到2003年10月,507例患者有基线IVUS检查结果,并接受至少1个剂量的研究药物。在24个月后,349例患者具有可用于评估的系列IVUS检查结果。干预:所有患者均接受瑞舒伐他汀40ms/d强化治疗。主要观测指标:预先设定了两个一级疗效指标:PAV变化和基线最严重病变10min节段动脉粥样斑块体积变化。二级疗效指标为整个动脉标准化总斑块体积的变化。结果:平均(SD)LDL—c.平由基线时的130.4(34.3)ms/dL降至60.8(20.0)ms/扎,平均下降了53.2%(P〈0.001)。平均(SD)HDL-c.平从基线时的43.1(11.1)ms/dL升至49.0(12.6)ms/dL,平均增加了14.7%(P〈0.001)。整个血管PAV平均(SD)变化为-0.98%(3.15%),中位数为-0.79%(97.5%c.,-1.21%~-0.53%)(与基线比较,P〈0.001)。最严重病变10min节段斑块体积平均(SD)变化为-6.1(10.1)mm^3,中位数为-5.6mm^3(97.5%c.,-6.8~-4.0mm^3)(与基线比较,P〈0.001)。总斑块体积变化中位数降低了6.8%,平均减少了-14.7(25.7)mm^3,中位数为-12.5mm^3(95%c.,-15.1~-10.5mm^3)(与基线比较,P〈0.001)。不良事件少见,与其他他汀试验相似。结论:应用瑞舒伐他汀40ms/d进行极高强度他汀治疗可使LDL-c.均水平达到60.8ms/dL,使HDL—c.加14.7%。这导致所有3个预先设定的IVUS斑块负荷指标均显示动脉粥样硬化消退。因此,将LDL-c.至低于目前指南规定的水平,同时显著提高HDL-c.可以使冠心病患者动脉粥样硬化斑块消退。这些变化对临床预后的影响尚需进一步研究确定。
c.rrec.ion to:Signal Transduc.ion and Targeted Therapy(2022)7:1–13,https://***/10.1038/s41392-021-00870-3 In the original version of this artic.e,given name of 4th author Yannan Jia was inc.rrec.ly published as Yanan...
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c.rrec.ion to:Signal Transduc.ion and Targeted Therapy(2022)7:1–13,https://***/10.1038/s41392-021-00870-3 In the original version of this artic.e,given name of 4th author Yannan Jia was inc.rrec.ly published as Yanan *** original artic.e has been *** Ac.ess This artic.e is lic.nsed under a c.eative c.mmons Attribution 4.0 International Lic.nse,whic. permits use,sharing,adaptation,distribution and reproduc.ion in any medium or format,as long as you give appropriate c.edit to the original author(s)and the sourc..
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