阿托伐他汀联合氯吡格雷在颅外段颈动脉狭窄患者血管介入术中的应用
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摘要
目的探讨阿托伐他汀联合氯吡格雷在颅外段颈动脉狭窄(extracranial carotid stenostic,ECS)患者血管介入术中的应用。方法选取择期行血管介入术的82例ECS患者为研究对象,随机分为接受阿托伐他汀+氯吡格雷治疗的联合组(41例)和术后接受氯吡格雷治疗的对照组(41例),比较2组术后疗效和安全性。结果 2组手术支架植入成功率均为100%,2组术后3个月头颈CT血管造影均未发现再狭窄;2组术后3个月美国国立卫生研究院卒中量表评分、低密度脂蛋白胆固醇、总胆固醇、三酰甘油、颈动脉内中膜厚度、斑块数量和面积均显著下降(P<0.05);简易智力状况检查评分、高密度脂蛋白胆固醇均显著上升(P<0.05),且联合组各指标变化幅度均大于对照组(P<0.05);术后3个月2组血小板膜糖蛋白(CD62p、CD63p、GPⅡb/Ⅲa受体复合物)均显著下降(P<0.05),而联合组各血小板活化指标与对照组差异无统计学意义(P>0.05);2组并发症总发生率差异无统计学意义(P>0.05)。结论阿托伐他汀联合氯吡格雷可有效改善行血管介入术ECS患者的预后,改善血脂水平、神经功能缺损和认识功能,控制血小板活化。
Objective To investigate the application of atorvastatin combined with clopidogrel inintravascular interventionof patients with extracranial carotid stenosis(ECS).Methods A total of 82 patients with ECS who underwent electiveintravascular intervention in the department of neurology in the hospital were selected as study subjects,and they were randomly divided into the combined group(treated with atorvastatin combined with clopidogrel,n=41)and the control group(treated with clopidogrelafter operation,n=41).The curative effect and safety were compared between the two groups.Results The successful rate of stent implantation in the two groups was 100%.The head and neck CT angiography showed no restenosis in the two groups in 3 months after operation.The scores of National Institutes of Health Stroke Scale,low-density lipoprotein cholesterol,total cholesterol,triglyceride,carotid artery intima-media thickness,and the number and area of plaques were significantly decreased while Mini-Mental State Examination score and high-density lipoprotein cholesterol were significantly increased in the two groups in 3 months after operation(P<0.05).Changes of above-mentioned indexes in the combined group were greater than those in the control group(P<0.05).The platelet membrane glycoproteins(CD62 p,CD63 p,GP Ⅱb/Ⅲ a receptor complex)were significantly decreased in the two groups in 3 months after operation(P<0.05),but there was no significant difference between the two groups in platelet activation indexes(P>0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion Atorvastatin combined with clopidogrel can effectively improve the prognosis of ECS patients withintravascular intervention,improve blood lipid levels, relieve neurological impairment,improve cognitive function,and control platelet activation.
Objective To investigate the application of atorvastatin combined with clopidogrel inintravascular interventionof patients with extracranial carotid stenosis(ECS).Methods A total of 82 patients with ECS who underwent electiveintravascular intervention in the department of neurology in the hospital were selected as study subjects,and they were randomly divided into the combined group(treated with atorvastatin combined with clopidogrel,n=41)and the control group(treated with clopidogrelafter operation,n=41).The curative effect and safety were compared between the two groups.Results The successful rate of stent implantation in the two groups was 100%.The head and neck CT angiography showed no restenosis in the two groups in 3 months after operation.The scores of National Institutes of Health Stroke Scale,low-density lipoprotein cholesterol,total cholesterol,triglyceride,carotid artery intima-media thickness,and the number and area of plaques were significantly decreased while Mini-Mental State Examination score and high-density lipoprotein cholesterol were significantly increased in the two groups in 3 months after operation(P<0.05).Changes of above-mentioned indexes in the combined group were greater than those in the control group(P<0.05).The platelet membrane glycoproteins(CD62 p,CD63 p,GP Ⅱb/Ⅲ a receptor complex)were significantly decreased in the two groups in 3 months after operation(P<0.05),but there was no significant difference between the two groups in platelet activation indexes(P>0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion Atorvastatin combined with clopidogrel can effectively improve the prognosis of ECS patients withintravascular intervention,improve blood lipid levels, relieve neurological impairment,improve cognitive function,and control platelet activation.
引文
[1]刘奇,郭飞,赵宇,等.颈动脉支架成形术治疗颅外段颈动脉夹层的疗效观察[J].卒中与神经疾病,2016,23(4):228-231.
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[11]彭凌云,丁怀胜,李原,等.氯吡格雷低反应的高危冠心病患者改用替格瑞洛抗血栓治疗效果观察[J].河北医科大学学报,2016,37(12):1370-1373.
[12] Saati S,Abrams-Ogg ACG,Blois SL,et al.Comparison of Multiplate,Platelet Function Analyzer-200,and Plateletworks in Healthy Dogs Treated with Aspirin and Clopidogrel[J].J Vet Intern Med,2018,32(1):71-72.
[13]李然,王德良,王文素.术前强化阿托伐他汀联合充分水化疗法对PCI术后并发造影剂肾病的影响[J].河北医科大学学报,2017,38(3):262-265.
[14]王鹏,严妍,于文君,等.阿托伐他汀与瑞舒伐他汀对冠心病患者的疗效与安全性对比观察[J].中国医院药学杂志,2018,38(2):169-172.
[15]姚立军,陈弹.瑞舒伐他汀与阿托伐他汀对冠心病患者血脂、动脉粥样硬化程度和血管内皮舒张功能的疗效对比[J].中国药房,2017,28(35):4963-4966.
[16]徐正虎,王君.颈动脉支架置入术后并发症及处理方法[J].中华老年心脑血管病杂志,2015,17(8):837-840.
[2]戚悠飞,肖占祥,曾昭凡,等.症状性颈内动脉闭塞的术前评估及手术治疗[J].中国普通外科杂志,2016,25(12):1707-1712.
[3]高鹏,马妍,王亚冰,等.颅内大动脉慢性闭塞血管内再通的可行性和安全性分析[J].中国脑血管病杂志,2017,14(8):405-409.
[4] Tsoumani ME,Tatsidou PT,Ntalas IV,et al.Dynamic platelet adhesion in patients with an acute coronary syndrome:the effect of antiplatelet therapy[J].Platelets,2016,27(8):812-820.
[5] Wang H,Qi J,Li Y,et al. Pharmacodynamics and Pharmacokinetics of Ticagrelor Versus Clopidogrel in Patients with Acute Coronary Syndromes and Chronic Kidney Disease[J].Br J Clin Pharmacol,2017,84(1):88-96.
[6]中华医学会外科学分会血管外科学组.颅外段颈动脉狭窄治疗指南[J].中国实用外科杂志,2008,28(11):913-915.
[7]黄圣明,王明科,郑春玲,等.血管内支架植入术治疗症状性颅内动脉狭窄的临床研究[J].中风与神经疾病杂志,2016,33(12):1126-1127.
[8]李菁,韩冰莎,贺迎坤,等.重度颈动脉狭窄腔内支架植入术后认知功能临床研究[J].介入放射学杂志,2015,24(11):943-945.
[9] Selwaness M,Bos D,van den Bouwhuijsen Q,et al.Carotid Atherosclerotic Plaque Characteristics on Magnetic Resonance Imaging Relate With History of Stroke and Coronary Heart Disease[J].Stroke,2016,47(6):1542-1547.
[10]张利通,董文涛,高峰,等.颈动脉狭窄患者术后并发症影响因素的研究现状[J].中华神经外科杂志,2015,31(1):98-101.
[11]彭凌云,丁怀胜,李原,等.氯吡格雷低反应的高危冠心病患者改用替格瑞洛抗血栓治疗效果观察[J].河北医科大学学报,2016,37(12):1370-1373.
[12] Saati S,Abrams-Ogg ACG,Blois SL,et al.Comparison of Multiplate,Platelet Function Analyzer-200,and Plateletworks in Healthy Dogs Treated with Aspirin and Clopidogrel[J].J Vet Intern Med,2018,32(1):71-72.
[13]李然,王德良,王文素.术前强化阿托伐他汀联合充分水化疗法对PCI术后并发造影剂肾病的影响[J].河北医科大学学报,2017,38(3):262-265.
[14]王鹏,严妍,于文君,等.阿托伐他汀与瑞舒伐他汀对冠心病患者的疗效与安全性对比观察[J].中国医院药学杂志,2018,38(2):169-172.
[15]姚立军,陈弹.瑞舒伐他汀与阿托伐他汀对冠心病患者血脂、动脉粥样硬化程度和血管内皮舒张功能的疗效对比[J].中国药房,2017,28(35):4963-4966.
[16]徐正虎,王君.颈动脉支架置入术后并发症及处理方法[J].中华老年心脑血管病杂志,2015,17(8):837-840.