CAJ | 학술논문

目的评价症状性颈内动脉完全闭塞患者介入治疗和药物治疗的效果,观察临床干预后血管事件的随访结果.方法将自2004年2月至2009年1月在聊城市人民医院和南京军区南京总医院神经内科住院的62例症状性颈内动脉完全闭塞患者意向性分为介入组和药物组,介入组21例给予颈内动脉闭塞血管再通术,药物组41例给予阿司匹林、氯吡格雷及他汀类药物治疗.随访主要终点事件为发病2年时患者功能预后,以改良的Rankins评分(mRS评分)为依据,秩和检验比较组间平均秩次的差异；次要终点事件为血管事件的再发,Kaplan-Meier法及多因素Cox回归分析其中位数时间及独立危险因素.结果在随访3月、6月、1年及2年时,介入组患者mRS评分平均秩次均明显低于药物组,差异有统计学意义(P＜0.05).介入组和药物组患者再发血管事件的中位数时间分别为(17.42± 1.20)个月和(19.43±1.51)个月,比较差异无统计学意义(P＞0.05).多因素Cox回归分析表明患者再发血管事件的独立危险因素主要包括吸烟(RR=3.189,95％ CI:1.020～9.968,P=0.046)、糖尿病(RR=2.717,95％CI:1.113～6.631,P=0.028)及基线时美国国立卫生研究院卒中量表(NIHSS)评分(RR=2.984,95％CI:1.049～8.485,p=0.040),而治疗方案(介入治疗和药物治疗)不是血管事件再发的独立影响因素(RR=1.191,95％CI:0.430～3.296,P=0.737).结论对于症状性颈内动脉完全闭塞患者,介入治疗较药物治疗能获得更好的功能预后,但随访2年时未能减少血管事件的发生.吸烟、糖尿病及基线NIHSS评分是其血管事件再发的独立危险因素.
목적 평개증상성경내동맥완전폐새환자개입치료화약물치료적효과,관찰림상간예후혈관사건적수방결과.방법 장자2004년2월지2009년1월재료성시인민의원화남경군구남경총의원신경내과주원적62례증상성경내동맥완전폐새환자의향성분위개입조화약물조,개입조21례급여경내동맥폐새혈관재통술,약물조41례급여아사필림、록필격뢰급타정류약물치료.수방주요종점사건위발병2년시환자공능예후,이개량적Rankins평분(mRS평분)위의거,질화검험비교조간평균질차적차이；차요종점사건위혈관사건적재발,Kaplan-Meier법급다인소Cox회귀분석기중위수시간급독립위험인소.결과 재수방3월、6월、1년급2년시,개입조환자mRS평분평균질차균명현저우약물조,차이유통계학의의(P＜0.05).개입조화약물조환자재발혈관사건적중위수시간분별위(17.42± 1.20)개월화(19.43±1.51)개월,비교차이무통계학의의(P＞0.05).다인소Cox회귀분석표명환자재발혈관사건적독립위험인소주요포괄흡연(RR=3.189,95％ CI:1.020～9.968,P=0.046)、당뇨병(RR=2.717,95％CI:1.113～6.631,P=0.028)급기선시미국국립위생연구원졸중량표(NIHSS)평분(RR=2.984,95％CI:1.049～8.485,p=0.040),이치료방안(개입치료화약물치료)불시혈관사건재발적독립영향인소(RR=1.191,95％CI:0.430～3.296,P=0.737).결론 대우증상성경내동맥완전폐새환자,개입치료교약물치료능획득경호적공능예후,단수방2년시미능감소혈관사건적발생.흡연、당뇨병급기선NIHSS평분시기혈관사건재발적독립위험인소.
Objective To evaluate the effects of artery-interventional therapy and drug treatment on patients with symptomatic carotid artery total occlusion,and observe the follow-up results of cerebrovascular events after clinical interference.Methods According to patient′s intention,62patients with symptomatic carotid artery total occlusion,admitted to our hospitals from February 2004 to January 2009,were divided into artery-interventional therapy group(n=21)and drug treatment group (n=41).In the artery-interventional therapy group,patients were given revascularization of internal carotid by endovascular intervention.In the drug treatment group,patients were given aspirin,clopidogrel and statins.The major end-point outcome of follow-up survey was the 2-year functional prognosis evaluated by modified Rankin Scale(mRS),and Rank sum test was employed to compare the differences of mean rank of the 2 groups; the minor end-point outcome was the cardiovascular events,and Kaplan-Meier method and multivariate Cox regression were employed to analyze the median time and independent risk factors.Results During the 3,6 and 9 months,1 and 2 years of follow-up,mRS average ranks in the artery-interventional therapy group were statistically lower than those in the drug treatment group(P＜0.05).The median times of recurrence of cardio-cerebrovascular events in the artery-interventional therapy group and drug treatment group were(17.42±1.20)months(95％CI:15.07-19.76)and(19.43±1.51)months(95％CI:16.48-22.38),respectively,and Kaplan-Meier analysis showed no significant difference(P＞0.05).Survival Cox regression analysis showed that independent factors of cardio-cerebrovascular events were smoking(RR=3.189,95％CI:1.020-9.968,P=0.046),diabetes(RR=2.717,95％CI:1.113-6.631,P=0.028),and baseline NIHSS scores(RR=2.984,95％CI:1.049-8.485,P=0.040),but treatment methods(artery-interventional therapy and drug treatment)were not independent factors(RR=1.191,95％CI:0.430-3.296,P=0.737).Conclusion Artery-interventional therapy is superior to drug therapy in achieving better functional prognosis; however,the 2-year-follow-up shows that the artery-interventional therapy can not reduce the occurrence of cardio-eerebrovascular events.Smoking,diabetes and baseline NIHSS scores are independent factors of recurrence of cardio-cerebrovascular events.