摘要
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10mg／d，后者在常规治疗基础上加服瑞舒伐他汀20mg／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一中膜厚度（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；t=0．513，P=0．609]、低密度脂蛋白胆固醇（10w—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-densicy 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；t=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）mm。对（0．85±0．34）mm^2；t=0．261，P=0．749]和Crouse积分[（4．26±0．31）mm对（4．184-0．25）mm；t=1．171，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）mm。对（0．70±0．25）mm^2；归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％x^2=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20mg／d的作用优于10mg／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 rosuvastatln 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 lntima-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 mmoYL; t = 0. 513, P = 0. 609）, lowdensity lipoproteln 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 lipoproteln 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 mm^2; 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 mm^2 vs.0. 70 ± 0.25 mm^2; 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 lschemic events in the high-dose group was significantly lower than that in the conventional dose group （11.76% vs. 29.41% ; X^2 = 3. 202, P = 0. 001 ）. Conclusions Rosuvastatln has significant lipid-lowering effect. It can eliminate or stabilize carotid vulnerable plaque and reduce ischemic stroke events. The effect of rosuvastatln 20 mg/d is superior to that of rosuvastatln 10 mg/d.
出处
《国际脑血管病杂志》
2015年第4期249-254,共6页
International Journal of Cerebrovascular Diseases
