阿托伐他汀钙联合普罗布考预防椎动脉支架术后再狭窄及相关研究

发布时间：2018-05-29 21:23

本文选题：椎动脉支架术后 + 再狭窄　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:观察阿托伐他汀钙联合应用普罗布考对椎动脉支架成形术术后再狭窄的影响以及对炎症因子高敏C-反应蛋白(high sensitive C-reactive protein,hs-CRP)、外周血氧化型低密度脂蛋白(oxidized low density lipoprotein,ox-LDL)指标的影响,评价并比较与阿托伐他汀钙治疗对椎动脉支架成形术术后患者的临床疗效,进一步探究两种药物联用在临床应用的安全性以及在预防缺血性脑血管病事件中的作用。方法:将2016年01月至2016年06月就诊于邢台市第三医院神经内科并且行椎动脉支架成形术术后的患者共60例,随机分为A组(阿托伐他汀钙组)和B组(联合治疗组),每组各30例。两组患者均给予健康教育、戒烟限酒、饮食指导以及改善生活方式,同时给予控制血压、血糖等常规治疗。A组患者给予阿托伐他汀钙片20mg 1/晚治疗,B组采用阿托伐他汀钙片20mg 1/晚+普罗布考0.5g 2/日联合治疗。随访观察6个月,分别于术后及术后1,3,6个月,行颈部血管超声评估椎动脉支架术后再狭窄情况,并观察治疗前后血脂水平,hs-CRP以及ox-LDL水平的变化。在随访过程中,监测患者肝、肾功能、心肌酶及心电图,观察有无脑卒中事件的再发并记录不良反应事件的发生情况。结果:1两组支架术后再狭窄率的比较分别于术后及术后1,3,6个月,行颈部血管超声评估椎动脉支架成形术术后支架部位再狭窄情况,观察颈部血管内径及血流流速并比较两组支架术后再狭窄率。于术后3个月,A、B两组患者的再狭窄率为10%(3/30)和6.89%(2/29),差异无统计学意义;而术后6个月的再狭窄率分别为20%(6/30)和10.34%(3/29),差异有统计学意义(P0.05)。2两组间脑卒中事件的再发率比较在术后6个月的随访时,A组中有3例再发脑卒中事件发生,而B组无再发脑卒中患者,差异具有统计学差异(P0.05)。3两组治疗前后hs-crp及ox-ldl水平变化的比较通过观察术后及术后1、3、6个月两组患者外周血中hs-crp及ox-ldl水平的变化,结果显示:与治疗前相比,两组患者外周血hs-crp的水平均有不同程度的降低。与a组相比,b组外周血hs-crp及ox-ldl水平显著下降,差异有统计学意义(p0.05)。4两组患者血脂水平的变化组内比较:与治疗前比较,术后3、6个月的两组患者外周血中tc、tg、ldl-c水平均明显下降,差异有统计学意义(p0.05),a组的hdl水平较治疗前升高,差异有统计学意义(p0.05),但b组的hdl水平较治疗前无明显变化(p0.05)。组间比较:治疗前两组患者外周血中的tc、tg、ldl-c、hdl水平无显著性差异(p0.05);而治疗6个月后,两组间tc、tg、ldl-c水平的比较有统计学差异,与a组相比,b组的tc、tg、ldl-c及hdl水平显著下降,差异均有统计学意义(p0.05)。5药物安全性评价在随访过程中,观察患者有无肌肉酸痛、疲劳,监测患者肝、肾功能、心肌酶及心电图,并记录不良反应事件的发生情况。a、b两组患者不良事件的发生率分别为13.3%、10.3%,其中a组患者中有4例、b组中3例出现肝酶alt及ast的轻度升高,但升高均3倍正常值。统计结果显示,两组之间不良事件的发生率差异无统计学意义(p0.05)。6术后再狭窄危险因素的评估对术后发生再狭窄患者的一般临床资料进行统计学分析,发现吸烟是造成再狭窄的危险因素,差异有统计学意义;而联合用药则降低了再狭窄的发病率(p0.05)。7多元logistic回归分析多元回归分析显示吸烟及联合用药是影响再狭窄的独立影响因素,其中联合用药是保护因素,降低了术后6个月再狭窄的发生率(p0.05)。结论:在本实验的样本内数据得出结论:对于椎动脉支架成形术术后的患者,阿托伐他汀钙联合普罗布考治疗能够1)显著调节患者的血脂水平;2)降低了椎动脉支架成形术术后的再狭窄率;3)使缺血性脑血管病患者的复发风险有效降低,药物不良事件的发生率较单用阿托伐他汀钙治疗并未明显增加。
[Abstract]:Objective: To evaluate and compare the effects of atorvastatin calcium combined with probucol on restenosis after vertebral artery stenting and the effects on the high sensitive C-reactive protein (hs-CRP) and the oxidative low density lipoprotein (oxidized low density lipoprotein, ox-LDL) of peripheral blood (oxidized low density lipoprotein, ox-LDL). The clinical efficacy of atorvastatin calcium treatment for patients with vertebral artery stenting, and further explore the safety of the two drugs combined in clinical application and the role in the prevention of ischemic cerebrovascular disease. Methods: from 2016 from 01 months to 06 months of 2016 in the Department of Neurology in the Third Hospital of Xingtai and the vertebral artery branch. 60 patients were divided into group A (atorvastatin calcium group) and group B (combined treatment group), with 30 cases in each group. The two groups were given health education, smoking cessation limited, diet guidance and improvement of life style, and routine treatment of group.A patients with control blood pressure and blood sugar given by Atorvastatin Calcium Tablets 20mg 1/ late treatment. The B group was treated with Atorvastatin Calcium Tablets 20mg 1/ late + propucol 0.5g 2/ day combined treatment. Follow up observation for 6 months, respectively, after the operation and 1,3,6 months after the operation, to evaluate the restenosis of the vertebral artery stenting after the neck vascular ultrasound, and observe the changes of blood lipid level, hs-CRP and ox-LDL level before and after treatment. During the follow-up process, the patients were monitored. Liver, renal function, myocardial enzyme and electrocardiogram were used to observe the recurrence of stroke events and to record the occurrence of adverse events. Results: 1 two groups after stent restenosis were compared after the operation and 1,3,6 months after the operation. The cervical vascular ultrasound was used to evaluate the restenosis of the stent position after the vertebral artery stenting, and the cervical blood was observed. The internal diameter and flow velocity were compared with the two groups of stent restenosis. The restenosis rate was 10% (3/30) and 6.89% (2/29) in the A and B two groups after 3 months of operation, but the restenosis rate was 20% (6/30) and 10.34% (3/29) in the 6 months after the operation, and the difference was statistically significant (P0.05) the recurrence rate of the apoplexy events in the.2 two group. After 6 months of follow-up, there were 3 cases of recurrent stroke in group A, and no recurrent stroke in group B (P0.05) the difference of hs-CRP and ox-LDL before and after treatment in group.3 two was compared by observing the changes of hs-CRP and ox-LDL levels in peripheral blood of the two groups of patients after the operation and in the 1,3,6 months after the operation. Compared with before treatment, the level of hs-CRP in the peripheral blood of the two groups decreased in varying degrees. Compared with the a group, the level of hs-CRP and ox-LDL in the peripheral blood of the group B decreased significantly. The difference was statistically significant (P0.05) the changes in the level of blood lipid in the group of.4 two: compared with before the treatment, TC, TG, LD in the peripheral blood of the two groups of patients after the postoperative 3,6 months. The level of L-C decreased significantly (P0.05), and the level of HDL in group A was higher than that before treatment (P0.05), but there was no significant change in HDL level in group B (P0.05). There was no significant difference between the two groups of patients before treatment, and there was no significant difference in the level of TC, TG, LDL-C, and HDL level in the peripheral blood of the patients before the treatment, and two after 6 months of treatment, two The levels of TC, TG, and LDL-C were statistically different between groups. Compared with group A, TC, TG, LDL-C and HDL decreased significantly in group B. The difference was statistically significant (P0.05).5 drug safety assessment during the follow-up process, the patients had no muscle pain, fatigue, monitoring the liver, renal function, myocardial enzyme and electrocardiogram, and recorded adverse events. The incidence of adverse events in the two group of B two was 13.3%, 10.3%, of which 4 cases were in group A, 3 cases in group B had a slight increase in ALT and AST, but the rise and rise were all 3 times normal. The statistical results showed that there was no statistical difference between the two groups of adverse events (P0.05) the risk factors for restenosis after.6 operation. The general clinical data of patients with restenosis after operation were statistically analyzed, and it was found that smoking was a risk factor for restenosis, and the difference was statistically significant, while the incidence of restenosis was reduced by combined use of drugs (P0.05).7 multiple logistic regression analysis and multivariate regression analysis showed that smoking and combined use of drugs were independent of restenosis. The combined use of drugs was a protective factor and reduced the incidence of restenosis after 6 months of operation (P0.05). Conclusion: in the sample of this experiment, it is concluded that for patients after vertebral artery stenting, atorvastatin calcium combined with probucol treatment can significantly regulate the level of blood lipid in patients; 2) lower vertebral movement. The restenosis rate after stent angioplasty; 3) reduced the risk of recurrence of the patients with ischemic cerebrovascular disease, and the incidence of adverse drug events did not increase significantly compared with the treatment of atorvastatin alone.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12

【参考文献】