强化他汀治疗对TIA患者有效性观察
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摘要
目的观察强化他汀治疗对短暂性脑缺血发作(TIA)患者临床预后的影响。方法选取2017年1月～11月收住于潍坊医学院附属医院神经内科的100例TIA合并大脑中动脉狭窄患者,随机分为强化组(n=50)和常规组(n=50),分别给予40mg,20mg阿托伐他汀钙治疗1年,期间进行随访,对比两组治疗后血脂、CRP、MCA狭窄程度变化、TIA复发情况。结果治疗后两组低密度脂蛋白胆固醇(LDL-C)、C反应蛋白(CRP)水平均较治疗前下降,两组比较差异有显著性(P<0.05)。治疗后对HDL-C升高水平比较无统计学差异(P=0.085)。强化组(22例)MCA狭窄好转例数多于常规组(9例),其进展例数(3例)少于常规组(10例),差异有统计学意义(P<0.05);两组MCA狭窄程度稳定例数比较无统计学差异(P=0.227)。强化组与常规组改善TIA预后的有效率分别为92%,76%,差异有统计学意义(P=0.029)。两组不良反应率分别为4%,2%,差异无统计学意义(P=0.558)。结论 40mg他汀在降低LDL-C与CRP水平、延缓或逆转脑血管狭窄、改善TIA临床预后方面优于20mg,且安全性较高。
Objective To observe the effect of intensive statin therapy on clinical prognosis of patients with transient ischemic attack(TIA).Methods One hundred TIA patients with middle cerebral artery stenosis admitted to the Affiliated Hospital of Weifang Medical University from January to November 2017 were randomly divided into intensive group(n=50) and routine group(n=50).40 mg and 20 mg atorvastatin calcium were given respectively for one year.During the follow up period,blood lipid,CRP,MCA stenosis degree and TIA recurrence were compared between the two groups after treatment.Results After treatment,the levels of LDL-C and CRP in the two groups were lower than those before treatment,and the difference between the two groups was significant(P<0.05).There was no significant difference in the level of HDL-C after treatment(P=0.085).The improvement of MCA stenosis in the intensive group(22 cases) was more than that in the conventional group(9 cases),and(3 cases)the progress of MCA stenosis was less than that in the conventional group(10 cases),the difference was statistically significant(P<0.05);there was no statistical difference in the invariant stenosis degree between the two groups(P=0.227).The effective rates of improving the prognosis of TIA in intensive group and conventional group were 92% and 76% respectively.There was significant difference between the two groups(P=0.029).The adverse reaction rates of the two groups were 4% and 2% respectively,with no significant difference(P=0.558). Conclusion 40 mg statin is superior to 20 mg in lowering LDL-C and CRP levels,delaying or reversing cerebrovascular stenosis and improving the clinical prognosis of TIA,and the safety is high.
Objective To observe the effect of intensive statin therapy on clinical prognosis of patients with transient ischemic attack(TIA).Methods One hundred TIA patients with middle cerebral artery stenosis admitted to the Affiliated Hospital of Weifang Medical University from January to November 2017 were randomly divided into intensive group(n=50) and routine group(n=50).40 mg and 20 mg atorvastatin calcium were given respectively for one year.During the follow up period,blood lipid,CRP,MCA stenosis degree and TIA recurrence were compared between the two groups after treatment.Results After treatment,the levels of LDL-C and CRP in the two groups were lower than those before treatment,and the difference between the two groups was significant(P<0.05).There was no significant difference in the level of HDL-C after treatment(P=0.085).The improvement of MCA stenosis in the intensive group(22 cases) was more than that in the conventional group(9 cases),and(3 cases)the progress of MCA stenosis was less than that in the conventional group(10 cases),the difference was statistically significant(P<0.05);there was no statistical difference in the invariant stenosis degree between the two groups(P=0.227).The effective rates of improving the prognosis of TIA in intensive group and conventional group were 92% and 76% respectively.There was significant difference between the two groups(P=0.029).The adverse reaction rates of the two groups were 4% and 2% respectively,with no significant difference(P=0.558). Conclusion 40 mg statin is superior to 20 mg in lowering LDL-C and CRP levels,delaying or reversing cerebrovascular stenosis and improving the clinical prognosis of TIA,and the safety is high.
引文
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[10] 张立,艾妮.氯吡格雷联合阿托伐他汀钙治疗短暂性脑缺血发作疗效观察[J].新乡医学院学报,2015,32(2):175～177.
[2] Guarino M,Rondelli F,Favaretto E,et al.Short and long-term stroke risk after urgent management of transient ischaemic attack:the Bologna TIA clinical pathway[J].Eur Neurol,2015,74(1-2):1～7.
[3] Li J,Wang Y,Lin J,et al.Soluble CD40L is a useful marker to predict future strokes in patients with minor stroke and transient ischemic attack [J].Stroke,2015,46(7):1990～1992.
[4] 祁风,徐恩,陆雪芬,等.缺血性卒中大脑中动脉狭窄患者脑血管反应能力的研究[J].中华超声影像学杂志,2004,3(6):470～471.
[5] Wickramatilake CM,Mohideen MR,Withanawasam BP,et a1.Testosterone and high-sensitive creactive protein in coronary artery disease patients awaiting coronary artery bypass graft[J].Andrologia,2015,47(5):493～498.
[6] Kernan WN,Ovbiagele B,Black HR,et al.Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack:a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke,2014,45(7):2160～2236.
[7] Adrià Arboix,Luis García-Eroles,Oliveres M,et al.Pretreatment with statins improves early outcome in patients with first-ever ischaemic stroke:A pleiotropic effect of statins or a beneficial effect of hypercholesterolemia[J].BMC Neurol,2010,10(1):47.
[8] Keene D,Price C,Shun-Shin MJ,et al.Effect on cardiovascular risk of high density lipoprotein targeted drug treatments niacin,fibrates,and CETP inhibitors:meta-analysis of randomised controlled trials including 117,411 patients[J].BMJ,2014,349:g4379.
[9] 李燕,王力力,赵新宇,等.大脑中动脉重度狭窄进程的影响因素分析[J].中国脑血管病杂志,2014,11(9):454～460.
[10] 张立,艾妮.氯吡格雷联合阿托伐他汀钙治疗短暂性脑缺血发作疗效观察[J].新乡医学院学报,2015,32(2):175～177.