他汀类与抗血小板药联合用药对缺血性脑血管病患者颈动脉粥样硬化的干预作用

Efficacy of intervention with statins and antiplatelet drugs for carotid arteriosclerosis in patients with ischemic cerebrovascular diseases

目的:探讨缺血性脑血管病患者联合应用他汀类及抗血小板药对颈动脉粥样硬化和脑血管事件的干预作用。方法:选择146例缺血性脑血管病合并颈动脉粥样硬化患者,将其随机分为治疗组和对照组。治疗组74例,应用氟伐他汀(每晚40mg)和拜阿斯匹灵(100mg/d),对照组72例,仅给拜阿斯匹灵(100mg/d)。共随访2年,分别在治疗前,治疗后6月、12月、18月、24月检测血脂,颈动脉内-中膜厚度,颈动脉斑块积分。结果:治疗组平均颈动脉内-中膜厚度和颈动脉斑块积分,治疗前分别为(1.22±0.19)mm和4.4±2.5,治疗后分别为(0.87±0.15)mm和2.8±1.1,治疗前后比较差异具有显著性(P<0.01)。随访结束时,治疗组缺血性脑血管病复发率9.5%,与对照组复发率(26.3%)相比明显下降。结论:联合应用他汀类及抗血小板药能延缓和逆转缺血性脑血管病患者颈动脉粥样硬化的进展,对缺血性脑血管病的复发有很好的预防作用,且不增加脑出血发生率。

Objective To inverstigate the efficacy of statins and antiplatelet drugs for carotid arteriosclerosis in patients with ischemic cerebrovascular disease. Method 146 patients with ischemic cerebrvascular disease and carotid arteriosclerosis were randomized into two groups. 74 cases in the treatment group, were treated with fluvastatin and aspirin,while 72 cases in the control group with aspirin alone. The serum lipids, intima-media thickness （IMT） of carotid arterial, carotid plaques score were measured before and once six months after treatment for 2 years. Results Meam IMT of carotid artery and carotid plaques scrore were （1.22±0.19） and （4.4±2.5） mm respectively in the treatment group before treatment, but they were （0.87±0.15） and （2.8±1.1） mm after 2 year treatment, which were reduced significantly compared with that of before treatment （P〈0.01）. cumulative incidence of ischemic cerebrovascular diseases in the treatment group were 9.5% during the 2 year fllow-up period, which were significantly lowered compared to the control group. Conclusion Long-term statim and antiplatelet drugs therapy could effectively delay and reverse the progression of carotid arterioclerosis in patients with ischemic cerebrovascular disease and prevent ischemic cerebrovascular diseases, and the incidence of intracerebral hemorrhage were not increased.