目的 探讨氯吡格雷联合阿托伐他汀钙治疗高血压合并颈动脉粥样硬化的临床疗效。方法 选取2011年1月—2014年12月江阴市中医院收治的高血压合并颈动脉粥样硬化患者120例,随机分为对照组和治疗组,每组各60例。对照组在常规治疗的基础上口服阿托伐他汀钙片20 mg/次,1次/d。治疗组在对照组的基础上口服硫酸氢氯吡格雷片75 mg/次,1次/d。两组均连续治疗3个月。比较两组患者治疗前后的临床疗效,血压,血脂指标总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C),颈动脉粥样硬化斑块面积和厚度,颈动脉粥样硬化斑块分级的变化。结果 治疗后,治疗组的总有效率(93.3%)明显高于对照组(70.0%),两组比较差异有统计学意义(P<0.05);治疗后,两组患者的收缩压和舒张压均较治疗前明显降低,差异具有统计学意义(P<0.05);治疗组治疗后的收缩压和舒张压均较对照组治疗后显著降低,差异有统计学意义(P<0.05);治疗后,两组的TC、TG、HDL-C、LDL-C均较治疗前显著改善,差异具有统计学意义(P<0.05);治疗组治疗后的TC、TG、HDL-C、LDL-C均较对照组治疗后显著改善,差异具有统计学意义(P<0.05);两组患者治疗后颈动脉粥样硬化斑块面积、厚度较治疗前均明显变小,差异有统计学意义(P<0.05);治疗组治疗后的颈动脉粥样硬化斑块面积和厚度均较对照组治疗后显著改善,差异具有统计学意义(P<0.05);治疗后,两组的颈动脉动脉粥样斑块均有改善,治疗前后比较差异具有统计学意义(P<0.05);且治疗组治疗后颈动脉动脉粥样斑块较对照组治疗后有所改善,且差异具有统计学意义(P<0.05)。结论 氯吡格雷联合阿托伐他汀钙治疗高血压合并颈动脉粥样硬化具有较好的临床疗效,能够有效减轻动脉粥样硬化,改善血压血脂,并稳定粥样斑块。

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.