毕小丽+胡建芳+杨沛群+刘媛

[摘要] 目的 觀察散结祛瘀复方联合阿托伐他汀对颈动脉粥样硬化易损斑块的干预作用。 方法 将广州市中西医结合医院2013年12月～2015年12月经颈动脉彩超确认为颈动脉粥样硬化易损斑块的患者112例按简单随机数字表法将其随机分为治疗组和对照组，其中对照组给予阿托伐他汀钙片，治疗组加用散结祛瘀复方口服，共治疗3个月。比较两组治疗前后颈动脉超声结果（颈动脉内膜中层厚度、斑块积分、斑块面积）以及血脂（总胆固醇、三酰甘油、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇）水平，并随访1年，记录脑血管事件发生情况。 结果 两组治疗后颈动脉内膜中层厚度、斑块面积、斑块积分、血脂水平均较治疗前有所改善（P < 0.05），且治疗组治疗后颈动脉内膜中层厚度、斑块面积、斑块积分和血脂水平均优于对照组，差异均有统计学意义（P < 0.05）。治疗组脑卒中发生率低于对照组，差异有统计学意义（P < 0.05）。 结论 阿托伐他汀单用或与散结祛瘀复方联用对颈动脉易损斑块均有一定的临床疗效，散结祛瘀复方联合阿托伐他汀较单用阿托伐他汀可更有效地缩小颈动脉内膜中层厚度、斑块面积和斑块积分，改善血脂水平，并最终降低脑卒中的发生率，值得在临床上进一步推广。

[关键词] 散结祛瘀复方；颈动脉粥样硬化；易损斑块；临床疗效

[中图分类号] R743 [文献标识码] A [文章编号] 1673-7210（2017）03（c）-0150-04

Intervention effect of Sanjie Quyu Compound combined with Atorvastatin for the vulnerable plaques of carotid artery

BI Xiaoli HU Jianfang YANG Peiqun LIU Yuan

Department of Internal Medicine， Guangzhou Hospital of Integrated Chinese and Western Medicine， Guangdong Province， Guangzhou 510800， China

[Abstract] Objective To observe the intervention effect of Sanjie Quyu Compound combined with Atorvastatin for the vulnerable plaques of carotid artery atherosclerosis. Methods One hundred and twelve patients with vulnerable plaques of carotid artery atherosclerosis diagnosed by carotid ultrasonography in Guangzhou Hospital of Integrated Chinese and Western Medicine from December 2013 to December 2015 were randomly divided into treatment group and control group by simple random number table method. The control group was treated with Atorvastatin， the treatment group was added with Sanjie Quyu Compound， orally， the course was 3 months. The carotid ultrasonography results （carotid intima-media thickness， plaque score， plaque area） and the levels of blood lipid （total cholesterol， triacylglycerol， low density lipoprotein cholesterin， high density lipoprotein cholesterol） before and after treatment between the two groups were compared， followed-up for 1 year， the occurrence of cerebrovascular events was recorded. Results After treatment， the carotid intima-media thickness， plaque score， plaque area and the levels of blood lipid in the two groups were all significantly improved compared with those before treatment （P < 0.05）， and the carotid intima-media thickness， plaque score， plaque area and the levels of blood lipid in the treatment group after treatment were better than those of control group， the differences were all statistically significant （P < 0.05）. The incidence of stroke events in the treatment group was lower than that of the control group， the difference was statistically significant （P < 0.05）. Conclusion Both application of Atorvastatin alone and combined with Sanjie Quyu Compound have certain clinical effects for the vulnerable plaques of carotid artery. Compared with Atorvastatin alone， Sanjie Quyu Compound combined with Atorvastatin has better effects in reducing carotid intima-media thickness， plaque score and plaque area， improving the levels of blood lipid and decreasing the incidence of stroke， which is worthy of promotion in clinic.

[Key words] Sanjie Quyu Compound； Carotid artery atherosclerosis； Vulnerable plaque； Clinical efficacy

“易损斑块”这一概念最早由Muller等[1]提出，当时用于描述不稳定、容易破裂导致急性冠状动脉综合征的斑块。随后Naghavi等[2]在2003年进一步完善了易损斑块的定义：所有具有破裂倾向、容易形成血栓和进展迅速的危险斑块。国内外研究表明颈动脉粥样硬化易损斑块和脑缺血事件的发生密切相关[3-4]，易损斑块的破裂、脱落造成的栓塞也是造成缺血性卒中的关键环节。因此，寻找有效方法对颈动脉易损斑块进行干预，对于减少缺血性卒中的发生具有重要的临床意义。本研究在中医理论的指导下采用散结祛瘀复方联合阿托伐他汀对患者颈动脉易损斑块进行干预，取得了较好的疗效，现将结果报道如下：