【摘要】：目的探討停用阿托伐他汀對(duì)老年急性腦梗死(ACI)患者頸動(dòng)脈易損斑塊及預(yù)后的影響。方法選取2012年2月—2015年9月沈陽醫(yī)學(xué)院附屬鐵法煤業(yè)集團(tuán)總醫(yī)院神經(jīng)內(nèi)科收治的老年ACI患者235例,入院后均行常規(guī)治療,出院后囑長期口服阿托伐他汀和阿司匹林。根據(jù)患者的服藥依從性,以出院后長期口服阿托伐他汀和阿司匹林的患者為觀察組(n=102);以出院1周后長期自行停用阿托伐他汀,僅應(yīng)用阿司匹林和基礎(chǔ)疾病治療藥物的患者為對(duì)照組(n=133)。分析并比較兩組患者發(fā)病時(shí)及發(fā)病6、12個(gè)月時(shí)的血脂指標(biāo)、頸動(dòng)脈內(nèi)-中膜厚度(IMT)、斑塊面積、斑塊指數(shù)以及發(fā)病12個(gè)月內(nèi)的腦梗死復(fù)發(fā)率、不良反應(yīng)發(fā)生率。結(jié)果兩組患者總膽固醇(TC)、三酰甘油(TG)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);不同時(shí)間點(diǎn)比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);組別和時(shí)間在TC、TG、LDL-C、HDL-C上存在交互作用(P0.05)。其中,發(fā)病6、12個(gè)月觀察組患者TC、TG、LDL-C低于對(duì)照組,發(fā)病12個(gè)月觀察組患者HDL-C高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者IMT、斑塊面積、斑塊指數(shù)比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);不同時(shí)間點(diǎn)比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05);組別和時(shí)間在IMT、斑塊面積、斑塊指數(shù)上存在交互作用(P0.05)。其中,發(fā)病6、12個(gè)月觀察組患者IMT、斑塊面積、斑塊指數(shù)低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。觀察組患者腦梗死復(fù)發(fā)率低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者不良反應(yīng)發(fā)生率比較,差異無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論阿托伐他汀具有降脂、抗動(dòng)脈粥樣硬化作用,并能穩(wěn)定頸動(dòng)脈易損斑塊,老年ACI患者盲目停用阿托伐他汀可增加腦梗死復(fù)發(fā)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.
【作者單位】： 沈陽醫(yī)學(xué)院附屬鐵法煤業(yè)集團(tuán)總醫(yī)院神經(jīng)內(nèi)科;沈陽醫(yī)學(xué)院附屬鐵法煤業(yè)集團(tuán)總醫(yī)院VIP病房;
【分類號(hào)】：R743.33

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