停用阿托伐他汀对老年急性脑梗死患者颈动脉易损斑块及预后的影响研究
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摘要
目的观察停用阿托伐他汀对老年急性脑梗死(ACI)患者颈动脉易损斑块及预后的影响及相关机制。方法采用回顾性研究方法,选择2015年1月至2017年8月在西安医学院第一附属医院神经内科接受常规治疗的165例老年ACI患者作为研究对象,根据患者出院之后是否坚持同时服用阿托伐他汀和阿司匹林分为两组,81例坚持同时服用阿托伐他汀和阿司匹林患者纳入观察组,84例出院后2周内自行停用阿托伐他汀但仍坚持服用阿司匹林患者纳入对照组;对比两组患者出院后1年内的脑梗死复发率和不良反应发生率,并观察两组患者发病时与出院后1年末次随访时的颈动脉内-中膜厚度(IMT)、斑块面积、斑块指数以及血脂指标(包括TC、TG、LDL-C、HDL-C)。结果观察组患者出院后1年的脑梗死复发率(7. 4%)低于对照组(23. 8%)(P <0. 05);两组的不良反应发生率(7. 4%vs. 8. 3%)比较差异无统计学意义(P> 0. 05);观察组患者出院后1年末次随访时的IMT(1. 24±0. 25 mm)、斑块面积(12. 55±4. 0mm~2)、斑块指数(1. 16±0. 10分)均低于对照组(1. 80±0. 29 mm、20. 57±4. 6 mm~2、2. 39±0. 36分)(P <0. 05);观察组患者出院后1年末次随访时的TC(3. 20±0. 33 mmol/L)、TG(2. 32±0. 70 mmol/L)、LDL-C(2. 11±0. 17 mmol/L)均低于对照组(5. 55±0. 78 mmol/L、3. 04±0. 78 mmol/L、4. 33±0. 65 mmol/L)(P <0. 05),HDL-C(0. 98±0. 20 mmol/L)高于对照组(0. 89±0. 19 mmol/L)(P <0. 05)。结论老年ACI患者经常规治疗出院后自行停用阿托伐他汀会增加脑梗死的复发风险,阿托伐他汀的降脂、抗动脉粥样硬化作用能够稳定颈动脉易损斑块,这可能是阿托伐他汀降低脑梗死复发风险的机制。
Objective To observe and evaluate the effect of atorvastatin withdrawal on carotid vulnerable plaque and prognosis in elderly patients with acute cerebral infarction( ACI) and its related mechanisms. Methods A retrospective study was conducted in 165 elderly patients with ACI who received routine treatment in the Department of Neurology of the First Affiliated Hospital of Xi'an Medical College from January 2015 to August 2017. Statin and aspirin patients were enrolled in the observation group( n = 81); those who withdrew atorvastatin within 2 weeks after discharge but still insisted on taking aspirin were enrolled in the control group( n = 84); the recurrence rate of cerebral infarction and the incidence of adverse reactions were compared between the two groups within 1 year after discharge,Relative parameters were observed at baseline and at 1 year after discharge,including intravenous-media thickness( IMT),plaque area,plaque index and blood lipid index( including TC,TG,LDL-C,HDL-C). Results The recurrence rate of cerebral infarction in observation group( 7. 4%) was lower than in control group( 23. 8%) one year after discharge( P < 0. 05),but there was no significant difference in adverse reaction occurrence between the two groups( 7. 4% vs. 8. 3%)( P > 0. 05). The IMT,plaque area and plaque index of observation group were all lower than in control group [( 1. 24 ±0. 25 mm,12. 55 ± 4. 0 mm~2 and 1. 16 ± 0. 10) vs.( 1. 80 ± 0. 29 mm,20. 57 ± 4. 6 mm~2 and 2. 39 ± 0. 36) ],( P < 0. 05). TC,TG and LDL-C in observation group were lower than in control group [( 3. 20 ± 0. 33 mmol/L,2. 32 ± 0. 70 mmol/L and 2. 11 ± 0. 17 mmol/L) vs.( 5. 55± 0. 78 mmol/L,3. 04 ± 0. 04 mmol/L,4. 33 ± 0. 65 mmol/L) ]( P < 0. 05). HDL-C in observation group was higher than that in control group [( 0. 98 ± 0. 20 mmol/L) vs.( 0. 89 ± 0. 19 mmol/L) ],( P < 0. 05). Conclusion Withdrawal of atorvastatin after routine treatment in elderly ACI patients after discharge can increase cerebral infarction recurrence risk. The mechanism of atorvastatin in reducing the risk of cerebral infarction recurrence might be related to its lipid-lowering and anti-atherosclerosis effects in stabilization of carotid vulnerable plaque.
Objective To observe and evaluate the effect of atorvastatin withdrawal on carotid vulnerable plaque and prognosis in elderly patients with acute cerebral infarction( ACI) and its related mechanisms. Methods A retrospective study was conducted in 165 elderly patients with ACI who received routine treatment in the Department of Neurology of the First Affiliated Hospital of Xi'an Medical College from January 2015 to August 2017. Statin and aspirin patients were enrolled in the observation group( n = 81); those who withdrew atorvastatin within 2 weeks after discharge but still insisted on taking aspirin were enrolled in the control group( n = 84); the recurrence rate of cerebral infarction and the incidence of adverse reactions were compared between the two groups within 1 year after discharge,Relative parameters were observed at baseline and at 1 year after discharge,including intravenous-media thickness( IMT),plaque area,plaque index and blood lipid index( including TC,TG,LDL-C,HDL-C). Results The recurrence rate of cerebral infarction in observation group( 7. 4%) was lower than in control group( 23. 8%) one year after discharge( P < 0. 05),but there was no significant difference in adverse reaction occurrence between the two groups( 7. 4% vs. 8. 3%)( P > 0. 05). The IMT,plaque area and plaque index of observation group were all lower than in control group [( 1. 24 ±0. 25 mm,12. 55 ± 4. 0 mm~2 and 1. 16 ± 0. 10) vs.( 1. 80 ± 0. 29 mm,20. 57 ± 4. 6 mm~2 and 2. 39 ± 0. 36) ],( P < 0. 05). TC,TG and LDL-C in observation group were lower than in control group [( 3. 20 ± 0. 33 mmol/L,2. 32 ± 0. 70 mmol/L and 2. 11 ± 0. 17 mmol/L) vs.( 5. 55± 0. 78 mmol/L,3. 04 ± 0. 04 mmol/L,4. 33 ± 0. 65 mmol/L) ]( P < 0. 05). HDL-C in observation group was higher than that in control group [( 0. 98 ± 0. 20 mmol/L) vs.( 0. 89 ± 0. 19 mmol/L) ],( P < 0. 05). Conclusion Withdrawal of atorvastatin after routine treatment in elderly ACI patients after discharge can increase cerebral infarction recurrence risk. The mechanism of atorvastatin in reducing the risk of cerebral infarction recurrence might be related to its lipid-lowering and anti-atherosclerosis effects in stabilization of carotid vulnerable plaque.
引文
[1]陈灏珠,林果为,王吉耀.实用内科学[M]. 14版.北京:人民卫生出版社,2013:1337-1352.
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[3]王灵红,章雅妮,李佳,等.阿托伐他汀钙与氢氯吡格雷联用对老年急性脑梗死患者颈动脉粥样硬化斑块的影响[J].中国老年学杂志,2015,35(21):6113-6114.
[4]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2):146-153.
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[7]杨海娜,李鹤松,杨昕,等.血浆同型半胱氨酸与颈动脉斑块稳定性的关系[J].中国实用内科杂志,2014,34(10):1012-1014.
[8]崔豹,马露,曾源,等.老年高血压患者颈动脉易损斑块与近期缺血性脑卒中的相关性[J].中华老年心脑血管病杂志,2013,15(12):1245-1248.
[9]Flint AC,Kamel H,Navi BB,et al. Statin use during ischemic stroke hospitalization is strongly associated with improved poststroke survival[J]. Stroke,2012,43(1):147-154.
[10]他汀类药物防治缺血性卒中/短暂性脑缺血发作专家共识组.他汀类药物防治缺血性卒中/短暂性脑缺血发作专家共识[J].中国卒中杂志,2013,8(7):565-575.
[11]周薇,罗飞,王浩.阿托伐他汀对急性缺血性脑卒中患者外周血VEGF及SDF-1的影响[J].临床和实验医学杂志,2017,16(17):1710-1713.
[12]张林,熊明,阳波,等.阿托伐他汀钙对老年颈动脉斑块面积的影响[J].中华老年心脑血管病杂志,2013,15(3):317-318.
[2]饶明俐.中国脑血管疾病防治指南[M].北京:人民卫生出版社,2007:3356-357.
[3]王灵红,章雅妮,李佳,等.阿托伐他汀钙与氢氯吡格雷联用对老年急性脑梗死患者颈动脉粥样硬化斑块的影响[J].中国老年学杂志,2015,35(21):6113-6114.
[4]中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组.中国急性缺血性脑卒中诊治指南2010[J].中华神经科杂志,2010,43(2):146-153.
[5]葛均波.徐永健内科学[M]. 8版.北京:人民卫生出版社,2013:145-151.
[6]刘铭,谢鹏.神经病学[M]. 7版.北京:人民卫生出版社,2013:246-247.
[7]杨海娜,李鹤松,杨昕,等.血浆同型半胱氨酸与颈动脉斑块稳定性的关系[J].中国实用内科杂志,2014,34(10):1012-1014.
[8]崔豹,马露,曾源,等.老年高血压患者颈动脉易损斑块与近期缺血性脑卒中的相关性[J].中华老年心脑血管病杂志,2013,15(12):1245-1248.
[9]Flint AC,Kamel H,Navi BB,et al. Statin use during ischemic stroke hospitalization is strongly associated with improved poststroke survival[J]. Stroke,2012,43(1):147-154.
[10]他汀类药物防治缺血性卒中/短暂性脑缺血发作专家共识组.他汀类药物防治缺血性卒中/短暂性脑缺血发作专家共识[J].中国卒中杂志,2013,8(7):565-575.
[11]周薇,罗飞,王浩.阿托伐他汀对急性缺血性脑卒中患者外周血VEGF及SDF-1的影响[J].临床和实验医学杂志,2017,16(17):1710-1713.
[12]张林,熊明,阳波,等.阿托伐他汀钙对老年颈动脉斑块面积的影响[J].中华老年心脑血管病杂志,2013,15(3):317-318.