目的 探討氯吡格雷聯(lián)合阿托伐他汀鈣治療高血壓合并頸動脈粥樣硬化的臨床療效。方法 選取2011年1月—2014年12月江陰市中醫(yī)院收治的高血壓合并頸動脈粥樣硬化患者120例,隨機分為對照組和治療組,每組各60例。對照組在常規(guī)治療的基礎(chǔ)上口服阿托伐他汀鈣片20 mg/次,1次/d。治療組在對照組的基礎(chǔ)上口服硫酸氫氯吡格雷片75 mg/次,1次/d。兩組均連續(xù)治療3個月。比較兩組患者治療前后的臨床療效,血壓,血脂指標總膽固醇(TC)、三酰甘油(TG)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C),頸動脈粥樣硬化斑塊面積和厚度,頸動脈粥樣硬化斑塊分級的變化。結(jié)果 治療后,治療組的總有效率(93.3%)明顯高于對照組(70.0%),兩組比較差異有統(tǒng)計學意義(P<0.05);治療后,兩組患者的收縮壓和舒張壓均較治療前明顯降低,差異具有統(tǒng)計學意義(P<0.05);治療組治療后的收縮壓和舒張壓均較對照組治療后顯著降低,差異有統(tǒng)計學意義(P<0.05);治療后,兩組的TC、TG、HDL-C、LDL-C均較治療前顯著改善,差異具有統(tǒng)計學意義(P<0.05);治療組治療后的TC、TG、HDL-C、LDL-C均較對照組治療后顯著改善,差異具有統(tǒng)計學意義(P<0.05);兩組患者治療后頸動脈粥樣硬化斑塊面積、厚度較治療前均明顯變小,差異有統(tǒng)計學意義(P<0.05);治療組治療后的頸動脈粥樣硬化斑塊面積和厚度均較對照組治療后顯著改善,差異具有統(tǒng)計學意義(P<0.05);治療后,兩組的頸動脈動脈粥樣斑塊均有改善,治療前后比較差異具有統(tǒng)計學意義(P<0.05);且治療組治療后頸動脈動脈粥樣斑塊較對照組治療后有所改善,且差異具有統(tǒng)計學意義(P<0.05)。結(jié)論 氯吡格雷聯(lián)合阿托伐他汀鈣治療高血壓合并頸動脈粥樣硬化具有較好的臨床療效,能夠有效減輕動脈粥樣硬化,改善血壓血脂,并穩(wěn)定粥樣斑塊。

Objective To investigate the clinical effect of clopidogrel combined with atorvastatin calcium in treatment of hypertension with carotid atherosclerosis. Methods Patients (120 cases) with hypertension with carotid atherosclerosis in Jiangyin Hospital of Traditional Chinese Medicine from January 2011 to December 2014 were randomly divided into control and treatment groups, and each group had 60 cases. The patients in the control group were po administered with Atorvastatin Calcium Tablets on the basis of conventional treatment, 20 mg/time, once daily. The patients in the treatment group were po administered with Clopidogrel Hydrogen Sulphate Tablets on the basis of the control group, 75 mg/time, once daily. The patients in two groups were treated for 3 months. After treatment, the efficacy was evaluated, and the changes of blood pressure, blood lipid indexes such as total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterin (HDL-C), low density lipoprotein cholesterin (LDL-C), carotid atherosclerotic plaque area and thickness, and carotid atherosclerosis plaque prioritization were compared. Results After treatment, the clinical efficacy of patients in treatment group (93.3%) were higher than those in control group (70.0%) with significant difference (P < 0.05). Systolic and diastolic blood pressures of two groups were lower than those before treatment with significant difference (P < 0.05). Systolic and diastolic blood pressures in treatment group were lower than those in control group, and the difference was significant (P < 0.05). After treatment, TC, TG, HDL-C, and LDL-C of two groups were improved more than those before treatment with significant difference (P < 0.05). TC, TG, HDL-C, and LDL-C in the treatment group were better than those in control group, and the difference was significant between two groups (P < 0.05). Carotid atherosclerotic plaque area and thickness of two groups were diminished more than those before treatment with significant difference (P < 0.05). Carotid atherosclerotic plaque area and thickness in treatment group were diminished more than those in the control group, and the difference was significant (P < 0.05). After treatment, carotid atherosclerotic plaques of two groups were improved more than that before treatment with significant difference (P < 0.05). Carotid atherosclerotic plaque in treatment group was better than those in control group, and there were significant difference (P < 0.05). Conclusion Clopidogrel combined with atorvastatin calcium has clinical curative effect in treatment of hypertension with carotid atherosclerosis, can effectively reduce the atherosclerosis, improve blood pressure and blood lipid, and stabilize the atherosclerotic plaque.