CAJ | 학술논문

目的探讨不同剂量阿托伐他汀对急性缺血性卒中患者早期神经功能恶化和短期转归的影响.方法前瞻性纳入125例急性缺血性卒中患者,随机分为标准治疗组(阿托伐他汀20 mg/d)和强化治疗组(阿托伐他汀40 mg/d).主要转归指标为治疗1周内早期神经功能恶化和治疗1个月时评价的转归良好(改良Rankin量表评分0～2分),次要指标为治疗1个月时美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分和不良事件.结果共纳入急性缺血性卒中患者125例,标准治疗组62例,强化治疗组63例.治疗1周时,标准治疗组早期神经功能恶化发生率显著性高于强化治疗组(16.13％对4.76％;x2 =4.333,P=0.038);治疗1个月时,标准治疗组转归良好的比例显著性低于强化治疗组(53.23％对71.43％;x2 =4.413,P=0.036).两组患者在治疗期间均未发生导致阿托伐他汀减量或停药的明显肝脏损害、肌肉毒性等不良事件.结论急性缺血性卒中急性期使用大剂量阿托伐他汀能较常规剂量降低早期神经功能恶化发生率,并改善短期临床转归.
목적 탐토불동제량아탁벌타정대급성결혈성졸중환자조기신경공능악화화단기전귀적영향.방법 전첨성납입125례급성결혈성졸중환자,수궤분위표준치료조(아탁벌타정20 mg/d)화강화치료조(아탁벌타정40 mg/d).주요전귀지표위치료1주내조기신경공능악화화치료1개월시평개적전귀량호(개량Rankin량표평분0～2분),차요지표위치료1개월시미국국립위생연구원졸중량표(National Institutes of Health Stroke Scale,NIHSS)평분화불량사건.결과 공납입급성결혈성졸중환자125례,표준치료조62례,강화치료조63례.치료1주시,표준치료조조기신경공능악화발생솔현저성고우강화치료조(16.13％대4.76％;x2 =4.333,P=0.038);치료1개월시,표준치료조전귀량호적비례현저성저우강화치료조(53.23％대71.43％;x2 =4.413,P=0.036).량조환자재치료기간균미발생도치아탁벌타정감량혹정약적명현간장손해、기육독성등불량사건.결론 급성결혈성졸중급성기사용대제량아탁벌타정능교상규제량강저조기신경공능악화발생솔,병개선단기림상전귀.
Objective To intestate the effect of different doses of atorvastatin on early neurological deterioration and short-term outcomes in patients with acute ischemic stroke.Methods The patients with acute ischemic stroke were enrolled prospectively.They were randomly assigned to either a standard therapy group (atorvastatin 20 mg/d) or an intensive treatment group (atorvastatin 40 mg/d).The primary outcomes were early neurological deterioration within 1 week of treatment and the good outcome of evaluation at 1 month after treatment (the modified Rankin Scale score 0-2); the secondary outcomes were the National Institutes of Health Stroke Scale (NIHSS) score and adverse events at 1 month.Results A total of 125 patients with acute ischemic stroke were enrolled,including 62 in the standard therapy group and 63 in the intensive treatment group.The incidence of early neurological deterioration at 1 week after treatment in the standard therapy group was significantly higher than that in the intensive treatment group (16.13％ vs.4.76％;x2=4.333,P=0.038); the proportion of good outcome in the standard therapy group was significantly lower than that in the intensive treatment group at 1 month after treatment (53.23％ vs.71.43％ ;x2 =4.413,P=0.036).During the treatment,no significant liver damage,muscle toxicity and other adverse events of causing atorvastatin reduction or withdrawal occurred in the patients of both groups.Conclusions Using high-dose atorvastatin in the acute phase of ischemic stroke may decrease the incidence of early neurological deterioration compared with the conventional dose,and improve short-term clinical outcomes.