国际脑血管病杂志
國際腦血管病雜誌
국제뇌혈관병잡지
INTERNATIONAL JOURNAL OF CEREBROVASCULAR DISEASES
2015年
4期
249-254
,共6页
脑缺血发作,短暂性%斑块,动脉粥样硬化%羟甲基戊二酰基CoA还原酶抑制剂%瑞舒伐他汀%治疗结果
腦缺血髮作,短暫性%斑塊,動脈粥樣硬化%羥甲基戊二酰基CoA還原酶抑製劑%瑞舒伐他汀%治療結果
뇌결혈발작,단잠성%반괴,동맥죽양경화%간갑기무이선기CoA환원매억제제%서서벌타정%치료결과
Ischemic Attack,Transient%Plaque,Atherosclerotic%Hydroxymethylglutaryl-CoA Reductase Inhibitors%Rosuvastatin%Treatment Outcome
目的 探讨不同剂量瑞舒伐他汀对短暂性脑缺血发作(transient ischemic attack,TIA)患者颈动脉易损斑块和脑缺血事件的影响.方法 前瞻性纳入存在颈动脉易损斑块的TIA患者,随机分为瑞舒伐他汀常规剂量组和大剂量组,前者在常规治疗基础上加服瑞舒伐他汀10 mg/d,后者在常规治疗基础上加服瑞舒伐他汀20 mg/d.随访6个月.治疗前后检测血脂,颈部血管超声检测颈动脉内膜-中膜厚度(intima-media thickness,IMT)、斑块面积和Crouse斑块积分.比较治疗后6个月内的脑缺血事件发生率.结果 共纳入71例患者,常规剂量组35例,大剂量组36例,常规剂量组和大剂量组分别失访2例和1例.大剂量组基线总胆固醇(total cholesterol,TC)[(5.65±1.05)mmol/L对(5.46±0.87) mmol/L;t=0.812,P=0.419]、三酰甘油(triglyceride,TG)[(2.85±0.74) mmol/L对(2.95±0.86) mmol/L;=0.513,P=0.609]、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)[(4.11±0.47) mmol/L对(4.08±0.33) mmol/L;t =0.304,P=0.761]和高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)[(1.27±0.22) mmol/L对(1.23±0.20) mmol/L;t=1.339,P=0.185]与常规剂量组差异无统计学意义;治疗后,大剂量组TC[(3.06±0.77) mmol/L对(4.98±0.78) mmol/L;t=10.214,P＜0.001]、TG[(2.15±0.56) mmol/L对(2.52±0.68) mmol/L;t=2.492,P=0.015]和LDL-C[(2.18±0.59) mmol/L对(3.86±0.42) mmol/L;t 13.526,P＜0.001]显著低于后组,而HDL-C[(1.43±0.20) mmol/L对(1.33±0.21) mmol/L;=2.010,P=0.048]显著高于常规剂量组.大剂量组基线IMT[(1.59±0.26)mm对(1.58±0.28)mm;t =0.152,P=0.879]、斑块面积[(0.87±0.29)mm2对(0.85±0.34)mm2;t=0.261,P=0.749]和Crouse积分[(4.26±0.31)mm对(4.18±0.25)mm;t1.171,P=0.245]与常规剂量组差异无统计学意义;治疗后大剂量组IMT[(1.26±0.25)mm对(1.44±0.27)mm;t=2.852,P=0.005]、斑块面积[(0.50±0.25) mm2对(0.70±0.25)mm2;t=3.298,P=0.001]和Crouse积分[(2.30±0.26)mm对(4.03±0.24) mm;t =28.509,P＜0.001]均较常规剂量组显著降低.大剂量组脑缺血事件发生率显著低于常规剂量组(11.76％对29.41％x2=3.202,P=0.001).结论 瑞舒伐他汀具有显著的降脂作用,能消除或稳定颈动脉易损斑块,减少缺血性卒中事件,瑞舒伐他汀20 mg/d的作用优于10 mg/d.
目的 探討不同劑量瑞舒伐他汀對短暫性腦缺血髮作(transient ischemic attack,TIA)患者頸動脈易損斑塊和腦缺血事件的影響.方法 前瞻性納入存在頸動脈易損斑塊的TIA患者,隨機分為瑞舒伐他汀常規劑量組和大劑量組,前者在常規治療基礎上加服瑞舒伐他汀10 mg/d,後者在常規治療基礎上加服瑞舒伐他汀20 mg/d.隨訪6箇月.治療前後檢測血脂,頸部血管超聲檢測頸動脈內膜-中膜厚度(intima-media thickness,IMT)、斑塊麵積和Crouse斑塊積分.比較治療後6箇月內的腦缺血事件髮生率.結果 共納入71例患者,常規劑量組35例,大劑量組36例,常規劑量組和大劑量組分彆失訪2例和1例.大劑量組基線總膽固醇(total cholesterol,TC)[(5.65±1.05)mmol/L對(5.46±0.87) mmol/L;t=0.812,P=0.419]、三酰甘油(triglyceride,TG)[(2.85±0.74) mmol/L對(2.95±0.86) mmol/L;=0.513,P=0.609]、低密度脂蛋白膽固醇(low-density lipoprotein cholesterol,LDL-C)[(4.11±0.47) mmol/L對(4.08±0.33) mmol/L;t =0.304,P=0.761]和高密度脂蛋白膽固醇(high-density lipoprotein cholesterol,HDL-C)[(1.27±0.22) mmol/L對(1.23±0.20) mmol/L;t=1.339,P=0.185]與常規劑量組差異無統計學意義;治療後,大劑量組TC[(3.06±0.77) mmol/L對(4.98±0.78) mmol/L;t=10.214,P＜0.001]、TG[(2.15±0.56) mmol/L對(2.52±0.68) mmol/L;t=2.492,P=0.015]和LDL-C[(2.18±0.59) mmol/L對(3.86±0.42) mmol/L;t 13.526,P＜0.001]顯著低于後組,而HDL-C[(1.43±0.20) mmol/L對(1.33±0.21) mmol/L;=2.010,P=0.048]顯著高于常規劑量組.大劑量組基線IMT[(1.59±0.26)mm對(1.58±0.28)mm;t =0.152,P=0.879]、斑塊麵積[(0.87±0.29)mm2對(0.85±0.34)mm2;t=0.261,P=0.749]和Crouse積分[(4.26±0.31)mm對(4.18±0.25)mm;t1.171,P=0.245]與常規劑量組差異無統計學意義;治療後大劑量組IMT[(1.26±0.25)mm對(1.44±0.27)mm;t=2.852,P=0.005]、斑塊麵積[(0.50±0.25) mm2對(0.70±0.25)mm2;t=3.298,P=0.001]和Crouse積分[(2.30±0.26)mm對(4.03±0.24) mm;t =28.509,P＜0.001]均較常規劑量組顯著降低.大劑量組腦缺血事件髮生率顯著低于常規劑量組(11.76％對29.41％x2=3.202,P=0.001).結論 瑞舒伐他汀具有顯著的降脂作用,能消除或穩定頸動脈易損斑塊,減少缺血性卒中事件,瑞舒伐他汀20 mg/d的作用優于10 mg/d.
목적 탐토불동제량서서벌타정대단잠성뇌결혈발작(transient ischemic attack,TIA)환자경동맥역손반괴화뇌결혈사건적영향.방법 전첨성납입존재경동맥역손반괴적TIA환자,수궤분위서서벌타정상규제량조화대제량조,전자재상규치료기출상가복서서벌타정10 mg/d,후자재상규치료기출상가복서서벌타정20 mg/d.수방6개월.치료전후검측혈지,경부혈관초성검측경동맥내막-중막후도(intima-media thickness,IMT)、반괴면적화Crouse반괴적분.비교치료후6개월내적뇌결혈사건발생솔.결과 공납입71례환자,상규제량조35례,대제량조36례,상규제량조화대제량조분별실방2례화1례.대제량조기선총담고순(total cholesterol,TC)[(5.65±1.05)mmol/L대(5.46±0.87) mmol/L;t=0.812,P=0.419]、삼선감유(triglyceride,TG)[(2.85±0.74) mmol/L대(2.95±0.86) mmol/L;=0.513,P=0.609]、저밀도지단백담고순(low-density lipoprotein cholesterol,LDL-C)[(4.11±0.47) mmol/L대(4.08±0.33) mmol/L;t =0.304,P=0.761]화고밀도지단백담고순(high-density lipoprotein cholesterol,HDL-C)[(1.27±0.22) mmol/L대(1.23±0.20) mmol/L;t=1.339,P=0.185]여상규제량조차이무통계학의의;치료후,대제량조TC[(3.06±0.77) mmol/L대(4.98±0.78) mmol/L;t=10.214,P＜0.001]、TG[(2.15±0.56) mmol/L대(2.52±0.68) mmol/L;t=2.492,P=0.015]화LDL-C[(2.18±0.59) mmol/L대(3.86±0.42) mmol/L;t 13.526,P＜0.001]현저저우후조,이HDL-C[(1.43±0.20) mmol/L대(1.33±0.21) mmol/L;=2.010,P=0.048]현저고우상규제량조.대제량조기선IMT[(1.59±0.26)mm대(1.58±0.28)mm;t =0.152,P=0.879]、반괴면적[(0.87±0.29)mm2대(0.85±0.34)mm2;t=0.261,P=0.749]화Crouse적분[(4.26±0.31)mm대(4.18±0.25)mm;t1.171,P=0.245]여상규제량조차이무통계학의의;치료후대제량조IMT[(1.26±0.25)mm대(1.44±0.27)mm;t=2.852,P=0.005]、반괴면적[(0.50±0.25) mm2대(0.70±0.25)mm2;t=3.298,P=0.001]화Crouse적분[(2.30±0.26)mm대(4.03±0.24) mm;t =28.509,P＜0.001]균교상규제량조현저강저.대제량조뇌결혈사건발생솔현저저우상규제량조(11.76％대29.41％x2=3.202,P=0.001).결론 서서벌타정구유현저적강지작용,능소제혹은정경동맥역손반괴,감소결혈성졸중사건,서서벌타정20 mg/d적작용우우10 mg/d.
Objective To investigate the effects of different doses rosuvastatin on carotid vulnerable plaques and cerebral ischemic events in patients with transient ischemic attack (TIA).Methods The TIA patients with carotid vulnerable plaques were enrolled retrospectively.They were randomly divided into either a rosuvastatin conventional dose group or a high-dose group.On the basis of conventional treatment,the former was also given rosuvastatin 10 mg/d,and on the basis of conventional treatment,the latter also took rosuvastatin 20 mg/d.The patients were followed up for 6 months.Blood lipid was detected before and after treatment.The carotid intima-media thickness (IMT),atherosclerotic plaque area,and Crouse plaque score were detected with cervical vascular ultrasound.The incidences of cerebral ischemic events were compared within six months after treatment.Results A total of 71 patients were enrolled.There were 35 patients in the conventional-dose group and 36 patients in the high-dose group.Two and one patients were lost to follow up respectively in both the conventional-dose group and the high-dose group.There were no significant differences in baseline total cholesterol (TC) (5.65 ± 1.05 mmol/L vs.5.46 ±0.87 mmol/L;t =0.812,P =0.419),triacylglycerol (TG) (2.85 ± 0.74 mmol/L vs.2.95 ± 0.86 mmol/L;t =0.513,P =0.609),low-density lipoprotein cholesterol (LDL-C) (4.11 ± 0.47 mmol/L vs.4.08 ± 0.33 mmol/L;t =0.304,P =0.761),and high-density lipoprotein cholesterol (HDL-C) (1.27 ± 0.22 mmol/Lvs.1.23 ± 0.20 mmol/L;t =1.339,P =0.185) between the high-dose group and the conventional dose group.After treatment,TC (3.06±0.77 mmol/L vs.4.98 ±0.78 mmol/L;t=10.214,P＜0.001),TG (2.15±0.56 mmol/L vs.2.52 ± 0.68 mmol/L;t =2.492,P =0.015),and LDL-C (2.18 ± 0.59 mmol/L vs.3.86 ± 0.42 mmol/L;t =13.526,P＜0.001) in the high-dose group were significantly lower than those in the latter,while HDL-C (1.43 ±0.20 mmol/L vs.1.33 ± 0.21 mmol/L;t =2.010,P =0.048) was significantly higher than the conventional dose group.There were no significant differences in baseline IMT (1.59 ± 0.26 mm vs.1.58 ± 0.28 mm;t =0.152,P =0.879),plaque area (0.87 ± 0.29 mm2 vs.0.85 ± 0.34 mm2;t =0.261,P =0.749),and Crouse score (4.26 ± 0.31 mm vs.4.18 ± 0.25 mm;t =1.171,P =0.245) between the high-dose group and the conventional dose group;after treatment,IMT (1.26 ± 0.25 mm vs.1.44 ±0.27 mm;t =2.852,P=0.005),plaque area (0.50±0.25 mm2 vs.0.70±0.25 mm2;t=3.298,P=0.001),and Crouse score (2.30 ±0.26 mm vs.4.03 ±0.24 mm;t =28.509,P ＜0.001) in the high-dose group were significantly decreased compared with the conventional dose group.The incidence of cerebral ischemic events in the high-dose group was significantly lower than that in the conventional dose group (11.76％ vs.29.41％;x2 =3.202,P =0.001).Conclusions Rosuvastatin has significant lipid-lowering effect.It can eliminate or stabilize carotid vulnerable plaque and reduce ischemic stroke events.The effect of rosuvastatin 20 mg/d is superior to that of rosuvastatin 10 mg/d.
