阿托伐他汀强化治疗可减少大脑中动脉支架置入后脑血管事件的发生

发布时间：2018-01-20 07:07

本文关键词： 脑梗死大脑中动脉支架植入术 s CD 阿托伐他汀　出处：《南方医科大学学报》2016年03期 　论文类型：期刊论文

【摘要】：目的观察已接受长期他汀治疗的脑梗死患者,大脑中动脉(middle cerebral artery,MCA)支架植入围手术期服用负荷剂量的阿托伐他汀对其近期脑血管事件的影响及机制探讨。方法选择2010年1月~2014年11月在我科接受大脑中动脉支架植入术的脑梗死患者40例。随机分为强化组(术前使用阿托伐他汀80 mg/d预处理3 d,术后原剂量巩固3 d,之后20 mg/d维持)和对照组(同期均匀给予阿托伐他汀20 mg/d),每组20例。抽血检测术前24 h、术后24 h血清high-sensitive C-reactive protein(hs-CRP)、soluable extracellular matrix metalloproteinase inducer(EMMPRIN/CD147)及soluable vascular cell adhesion molecule-1(sVCAM-1)水平变化;术后1个月行神经专科及DSA随访,观察主要终点事件(支架内急性血栓形成、再狭窄、短暂性脑缺血发作、脑梗死复发、再次介入治疗及死亡)的发生情况。结果两组术前24h各指标无差异(P0.05)。强化组术后24 h血清hs-CRP、s CD147及sVCAM-1水平显著低于对照组(P0.05);强化组血清hs-CRP、sCD147及sVCAM-1水平在支架植入术后较术前显著下降(P0.05)。对照组术后较术前有一定程度的升高(P0.05);术后1个月强化组主要终点事件发生率显著低于对照组(P0.05)。结论对于已接受长期他汀治疗的脑梗死患者,大脑中动脉支架植入围手术期服用负荷剂量的阿托伐他汀能显著降低血清hs-CRP、sCD147及sVCAM-1水平,减少脑血管事件的发生。
[Abstract]:Objective to observe the middle cerebral artery of middle cerebral artery in patients with cerebral infarction who have been treated with statins for a long time. MCA). The effect and mechanism of perioperative stenting with Atto vasvastatin on cerebral vascular events were investigated. Methods from January 2010 to November 2014, middle cerebral artery stenting was performed in our department. Forty patients with cerebral infarction undergoing implantation were randomly divided into two groups (. The patients were pretreated with Atto vastatin 80 mg/d for 3 days. The former dose was consolidated for 3 days and maintained at 20 mg/d after operation. The control group was given Atto vastatin 20 mg / d at the same time and 20 cases in each group. The blood samples were taken for 24 hours before operation. Serum high-sensitive C-reactive protein hs-CRP was found 24 hours after operation. Soluable extracellular matrix metalloproteinase inducer EMMPRIN / CD147). And the level of soluable vascular cell adhesion molecule-1sVCAM-1; One month after the operation, neurology and DSA were followed up to observe the main endpoints (acute thrombosis in stent, restenosis, transient ischemic attack and recurrence of cerebral infarction). Results there was no significant difference between the two groups in 24 hours before operation (P 0.05). The serum hs-CRP in the intensive group was 24 hours after operation. The levels of s CD147 and sVCAM-1 were significantly lower than those of the control group (P 0.05). Serum hs-CRP in the fortified group. The levels of sCD147 and sVCAM-1 decreased significantly after stent implantation compared with those before stent implantation. The levels of sCD147 and sVCAM-1 in the control group increased to a certain extent after stent implantation. One month after operation, the incidence of major endpoint events in the reinforcement group was significantly lower than that in the control group (P 0.05). Conclusion for the patients with cerebral infarction who have received long-term statins therapy. Middle cerebral artery stents implantation of Atto vastatin at perioperative loading dose significantly decreased serum hs-CRPnsCD147 and sVCAM-1 levels and reduced the occurrence of cerebrovascular events.
【作者单位】：南方医科大学南方医院神经内科;湖南师范大学第一附属医院//湖南省人民医院神经内科;
【基金】：2011年度湖南师范大学第一附属医院仁术科研课题基金 2011年度辉瑞中国血脂异常与动脉硬化科研基金
【分类号】：R743.3
【正文快照】： 卒中是严重威胁人类生命健康的一类疾病。介入治疗因其微创、安全的突出优势逐步成为治疗脑动脉狭窄的常用手段,但术中出现的斑块破裂、微血栓形成、内膜撕裂、内皮结构与功能的损伤以及术后支架内再狭窄等并发症成为影响疗效的重要因素[1],介入治疗围手术期药物应用策略至关

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