摘要
目的探讨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。方法选取2012年2月—2015年9月沈阳医学院附属铁法煤业集团总医院神经内科收治的老年ACI患者235例,入院后均行常规治疗,出院后嘱长期口服阿托伐他汀和阿司匹林。根据患者的服药依从性,以出院后长期口服阿托伐他汀和阿司匹林的患者为观察组(n=102);以出院1周后长期自行停用阿托伐他汀,仅应用阿司匹林和基础疾病治疗药物的患者为对照组(n=133)。分析并比较两组患者发病时及发病6、12个月时的血脂指标、颈动脉内-中膜厚度(IMT)、斑块面积、斑块指数以及发病12个月内的脑梗死复发率、不良反应发生率。结果两组患者总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)比较,差异有统计学意义(P<0.05);不同时间点比较,差异有统计学意义(P<0.05);组别和时间在TC、TG、LDL-C、HDL-C上存在交互作用(P<0.05)。其中,发病6、12个月观察组患者TC、TG、LDL-C低于对照组,发病12个月观察组患者HDL-C高于对照组,差异有统计学意义(P<0.05)。两组患者IMT、斑块面积、斑块指数比较,差异有统计学意义(P<0.05);不同时间点比较,差异有统计学意义(P<0.05);组别和时间在IMT、斑块面积、斑块指数上存在交互作用(P<0.05)。其中,发病6、12个月观察组患者IMT、斑块面积、斑块指数低于对照组,差异有统计学意义(P<0.05)。观察组患者脑梗死复发率低于对照组,差异有统计学意义(P<0.05)。两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论阿托伐他汀具有降脂、抗动脉粥样硬化作用,并能稳定颈动脉易损斑块,老年ACI患者盲目停用阿托伐他汀可增加脑梗死复发率。
Objective To investigate the effect of atorvastatin withdrawal on vulnerable carotid plaque and prognosis in elderly patients with acute cerebral infarction（ ACI）. Methods The enrolled participants were 235 elderly patients with ACI who received inpatient treatment in Department of Neurology,Tiefa Coal Industry Group General Hospital Affiliated to Shenyang Medical College from February 2012 to September 2015. All received the conventional treatment during the hospitalization and were prescribed long-term oral administration of atorvastatin and aspirin after discharge. Of them,those who long-termly orally took atorvastatin and aspirin after discharge were assigned to the observation group（ n = 102）,and those who voluntarily stopped taking atorvastatin at one week after discharge and only took aspirin and other drugs for basic disease were assigned to the control group（ n = 133）. Levels of blood lipid-related markers,carotid intima-media thickness（ CIMT）,carotid plaque area,plaque index measured at the onset of ACI,6 months and 12 months after the onset of ACI,recurrence rate of cerebral infarction and incidence of adverse reactions within 12 months after onset in both groups were analyzed and compared. Results The levels of TC,TG,LDL-C and HDL-C differed significantly between the two groups before and after treatment（ P〈0. 05）,and they varied by the time point of measurement（ P〈0. 05）. Treatment regimen and duration exerted interaction effects on the levels of TC,TG,LDL-C and HDL-C（ P〈0. 05）. The severity of CIMT, size of carotid plaque area and plaque index in the observation group were significantly different from those in the control group before and after treatment（ P〈0. 05）,and they were varied by the time point of measurement（ P〈0. 05）. Treatment regimen and duration produced interaction effects on the severity of CIMT,size of carotid plaque area and plaque index（ P〈0. 05）. The levels of TC,TG and LDL-C were lower in the observation group than in the control group at 6,12 months after the onset of ACI,but levels of HDL-C were higher in the observation group than in the control group at 12 months after the onset of ACI（ P〈0. 05）. The observation group had milder CIMT,smaller carotid plaque area,lower plaque index compared with the control group at 6,12 months after the onset of ACI（ P〈0. 05）. The recurrence rate of cerebral infarction in the observation group was lower than that in the control group（ P〈0. 05）. There was no significant difference in the incidence of adverse reactions between the two groups（ P〈0. 05）.Conclusion Atorvastatin can decrease the blood-lipid levels, control atherosclerosis, and stabilize the vulnerable carotid plaque in elderly ACI patients. Blindly and voluntarily stop taking atorvastatin can increase the recurrence rate of cerebral infarction.
作者
张艳影
石振东
ZHANG Yan-ying SHI Zhen-dong(Department of Neurology, Tiefa Coal Industry Group General Hospital Affiliated to Shenyang Medical College, Tieling 112700, China VIP Ward, Tiefa Coal Industry Group General Hospital Affiliated to Shenyang Medical College, Tieling 112700, China)
出处
《中国全科医学》
CAS
北大核心
2017年第28期3509-3514,共6页
Chinese General Practice
关键词
脑梗死
阿托伐他汀
停药
颈动脉易损斑块
预后
Brain infarction
Atorvastatin
Drug withdrawal
Vulnerable carotid plaque
Prognosis
