摘要
目的：比较不同剂量瑞舒伐他汀治疗青年缺血性卒中的高脂血症和颈动脉粥样硬化斑块疗效及安全性。方法前瞻性研究患有高脂血症合并颈动脉不稳定斑块的青年缺血性卒中患者264例，按照随机数字表法分为低剂量组、中剂量组、高剂量组，每组88例，各组患者均于每晚餐后顿服瑞舒伐他汀（托妥），剂量分别为5 mg、10 mg、20 mg，疗程均为8个月，观察三组患者的血脂和颈动脉粥样硬化斑块的变化，并通过观察临床症状及监测不良反应来评估其安全性。结果治疗前三组患者血脂及颈动脉粥样硬化斑块各指标比较，差异均无统计学意义（P ＞0．05）。治疗后三组患者血脂各指标比较，血清总胆固醇（TC）、三酰甘油（TG）和低密度脂蛋白（LDL-C）分别为高剂量组[（1．67±0．68）mmol／L、（3．23±0．53）mmol／L、（1．83±0．62）mmol／L]、中剂量组[（1．93±0．74）mmol／L、（3．73±0．23）mmol／L、（2．24±0．73）mmol／L]、低剂量组[（2．16±0．77）mmol／L、（4．06±0．93）mmol／L、（2．93±0．35）mmol／L]，均较治疗前高剂量组[（2．79±0．72）mmol／L、（5．40±0．67）mmol／L、（3．64±1．03）mmol／L]、中剂量组[（2．75±0．81）mmol／L、（5．59±0．95）mmol／L、（3．43±0．92）mmol／L]、低剂量组[（2．83±0．53）mmol／L、（5．84±0．79）mmol／L、（3．83±0．88）mmol／L]降低，且高剂量组的 TC、TG 和 LDL-C 降低较中、低剂量组明显，差异有统计学意义（F ＝6．61， P ＜0．05）。高剂量组总有效率85．23％，中剂量组总有效率76．14％，低剂量组总有效率62．50％，高剂量组的疗效优于低、中剂量组，差异有统计学意义（χ2＝5．79，P ＜0．05）。治疗后三组 IMT、斑块面积及 Crouse 积分分别为高剂量组[（0．92±0．41）mm、（0．52±0．56）mm、（3．07±0．58）mm]、中剂量组[（1．11±0．52）mm、（0．60±0．36）mm、（3．39±0．83）mm]、低剂量组[（1．42±0．87）mm、（0．81±0．91）mm、（4．09±0．77）mm]，均较治疗前高剂量组[（1．71±0．89）mm、（0．86±0．55）mm、（4．39±0．19）mm]、中剂量组[（1．74±1．03）mm、（0．89±0．48）mm、（4．42±0．53）mm]、低剂量组[（1．68±0．96）mm、（0．87±0．61）mm、（4．38±0．22）mm]降低，且高剂量组 IMT、斑块面积及 Crouse 积分降低较中、低剂量组明显，差异有统计学意义（F ＝5．83，P ＜0．05）。高剂量组总有效率78．41％，中剂量组总有效率52．27％，低剂量组总有效率30．68％，高剂量组的疗效优于低、中剂量组，差异有统计学意义（χ2＝5．37，P ＜0．05）。低剂量组发生10例（11．36％）不良反应，中剂量组发生12例（13．64％）不良反应，高剂量组14例（15．91％）发生不良反应；各组之间不良反应发生率的比较，差异无统计学意义（P ＞0．05），且均未见严重不良反应。结论瑞舒伐他汀治疗高脂血症合并颈动脉粥样硬化斑块的青年缺血性卒中患者，高剂量可以逆转斑块性质，减少斑块厚度，并降低血脂水平，疗效明显优于中、低剂量，且安全性好，未见严重不良反应，值得临床推广。
Objective To observe the efficacy and safety of rosuvastatin in the treatment of hyperlipidemia and carotid atherosclerotic plaque in young ischemic stroke patients.Methods In prospective study,264 young ischemic stroke patients with hyperlipidemia and carotid atherosclerotic plaque were randomly divided into low dose＆amp;nbsp;group,middle dose group,high dose group,88 cases in each group.All patients were given rosuvastatin immediately after dinner,in doses of 5mg,10mg,20mg,respectively,for eight months.Then,the changes of hyperlipidemia and carotid atherosclerotic plaque in the three groups were surveyed,and its safety by the observation of clinical symptoms and monitoring of adverse reactions after eight months were assessed.Results Before treatment,the blood fat and carotid atherosclerosis plaque index in the three groups had no statistically significant differences （all P 〉0.05）. After treatment,the total cholesterol,triglycerides,low -density lipoprotein cholesterol of the high dose group were （1.67 ±0.68）mmol/L,（3.23 ±0.53）mmol/L,（1.83 ±0.62）mmol/L,which of the middle dose group were （1.93 ±0.74）mmol/L,（3.73 ±0.23）mmol/L,（2.24 ±0.73）mmol/L,which of the low dose group were （2.16 ± 0.77）mmol/L,（4.06 ±0.93）mmol/L,（2.93 ±0.35）mmol/L.These indicators were decreased than before treat-ment [（2.79 ±0.72）mmol/L,（5.40 ±0.67）mmol/L,（3.64 ±1.03）mmol/L,（2.75 ±0.81）mmol/L,（5.59 ± 0.95）mmol/L,（3.43 ±0.92）mmol/L and （2.83 ±0.53）mmol/L,（5.84 ±0.79）mmol/L,（3.83 ±0.88）mmol/L].The decrease of the high dose group was higher than the middle and low dose group,the difference was statistically significant（F =6.61,P 〈0.05）.The effective rate of the high dose group was 85.23%.which of the middle dose group was 76.14%.The effective rate of the low dose group was 62.50%.The efficacy of the high dose group was better than the middle dose group and low dose group,the difference was statistically significant（χ2 =5.79,P 〈0.05）.After treatment,the intima -media thickness,plaque area and Crouse score of the high dose group were （0.92 ±0.41）mm,（0.52 ±0.56 ）mm,（3.07 ±0.58 ）mm,which of the middle dose group were （1.11 ± 0.52）mm,（0.60 ±0.36）mm,（3.39 ±0.83）mm,which of the low dose group were （1.42 ±0.87）mm,（0.81 ± 0.91）mm,（4.09 ±0.77）mm,which were decreased than before treatment[（1.71 ±0.89）mm,（0.86 ±0.55）mm, （4.39 ±0.19）mm,（1.74 ±1.03）mm,（0.89 ±0.48）mm,（4.42 ±0.53）mm and （1.68 ±0.96）mm,（0.87 ± 0.61）mm,（4.38 ±0.22）mm].The decrease of the high dose group was higher than the middle and low dose group, the difference was statistically significant （F =5.83,P 〈0.05 ）.The effective rate of the high dose group was 78.41%.The effective rate of the middle dose group was 52.27%.The effective rate of the low dose group was 30.68%.The efficacy of the high dose group was better than the middle dose group and low dose group,the difference was statistically significant（χ2 =5.37,P 〈0.05）.There were 10 cases （11.36%）had adverse reaction in the low dose group,12 cases （13.64%）in the middle dose group,14 cases （15.91%）in the high dose group.There was no statistically significant difference in incidence of adverse reactions among the three groups （P 〉0.05）,and no serious adverse reaction was found.Conclusion The high dose rosuvastatin treatment can reverse the nature of plaque, decrease the thickness of the plaques and lower blood lipid of young ischemic stroke with hyperlipidemia and carotid atherosclerotic plaque,which is better than middle and low dose,and has better security.There is no serious adverse reaction.It is worth for clinical promotion.
出处
《中国基层医药》
CAS
2016年第22期3383-3388,共6页
Chinese Journal of Primary Medicine and Pharmacy
基金
江苏省徐州矿务集团有限公司科技项目（2014-59）
