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

发布时间：2018-08-07 07:52

【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(P0.05);不同时间点比较,差异有统计学意义(P0.05);组别和时间在TC、TG、LDL-C、HDL-C上存在交互作用(P0.05)。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(P0.05)。两组患者IMT、斑块面积、斑块指数比较,差异有统计学意义(P0.05);不同时间点比较,差异有统计学意义(P0.05);组别和时间在IMT、斑块面积、斑块指数上存在交互作用(P0.05)。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(P0.05)。观察组患者脑梗死复发率低于对照组,差异有统计学意义(P0.05)。两组患者不良反应发生率比较,差异无统计学意义(P0.05)。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。
[Abstract]:Objective to investigate the effect of discontinuation of Atto vastatin on carotid plaque and prognosis in elderly patients with acute cerebral infarction (ACI). Methods from February 2012 to September 2015, 235 elderly patients with ACI were treated in Department of Neurology, General Hospital of Tiefa Coal Industry Group affiliated to Shenyang Medical College. All patients were given routine treatment after admission. After discharge, they were given long-term oral administration of Atto vastatin and aspirin. According to the compliance of the patients, the patients who took Atto vastatin and aspirin for a long time after discharge were used as the observation group (n = 102), and the patients stopped taking Atto vastatin on their own for a long time after one week after discharge. Patients treated only with aspirin and drugs for basic diseases were treated as control group (nn 133). The indexes of blood lipid, carotid intima-media thickness (IMT),) plaque area, plaque index, recurrence rate of cerebral infarction within 12 months and the incidence of adverse reactions were analyzed and compared between the two groups. Results there were significant differences in total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C) between the two groups (P0.05). The difference was statistically significant (P0.05), and there was an interaction between group and time on LDL-C (P0.05). Among them, the TCU TGG LDL-C in the observation group was lower than that in the control group at 6 and 12 months, and the HDL-C in the observation group was higher than that in the control group at 12 months after the onset, the difference was statistically significant (P0.05). IMT, plaque area, plaque index in the two groups, the difference was statistically significant (P0.05); at different time points, the difference was statistically significant (P0.05); groups and time in IMT, plaque area, plaque index on the interaction (P0.05). The IMT, plaque area and plaque index in the observation group were significantly lower than those in the control group (P0.05). The recurrence rate of cerebral infarction in the observation group was lower than that in the control group, and the difference was statistically significant (P0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P0.05). Conclusion Atto vastatin has the effect of lowering lipid and anti-atherosclerosis, and can stabilize the vulnerable plaque of carotid artery. Blind discontinuation of Atto vastatin in elderly patients with ACI can increase the recurrence rate of cerebral infarction.
【作者单位】：沈阳医学院附属铁法煤业集团总医院神经内科;沈阳医学院附属铁法煤业集团总医院VIP病房;
【分类号】：R743.33

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