阿托伐他汀对短暂性脑缺血发作患者预后的影响

Effects of Atorvastatin on Prognosis of Transient Ischemic Attack

目的探讨阿托伐他汀对短暂性脑缺血发作(TIA)患者预后的影响。方法在研究开始前1～6个月内曾有TIA、低密度脂蛋白胆固醇(LDL-C)在2.51～4.89 mmol.L-1且无已知冠心病的患者459例,随机分为对照组和治疗组。对照组239例患者,给予扩血管、抗血小板聚集及补充维生素等常规治疗;治疗组220例患者,在对照组治疗基础上加用阿托伐他汀60 mg.d-1,qd,po。出院后两组患者均口服阿司匹林(100 mg.d-1)和银杏叶片(40 mg,tid),治疗组在此基础上继续口服阿托伐他汀(60 mg.d-1)。双盲治疗,随访1 a,主要终点为首次非致死性或致死性卒中。结果治疗1 a后,治疗组与对照组患者的LDL-C平均水平分别为2.28和3.34 mmol.L-1(P<0.05)。在随访期间治疗组和对照组分别有36例(16.4%)和59例(24.7%)出现致死性或非致死性卒中(P<0.05)。治疗组出现30例脑梗死和6例出血性卒中,对照组出现53例脑梗死和6例出血性卒中。与对照组相比,治疗组发生脑梗死的概率明显减少(P<0.05);严重心血管事件的风险明显降低(P<0.05)。而两组发生脑出血的概率差异无显著性(P>0.05)。治疗组有7例死亡,对照组有5例死亡,两组总病死率相似(P>0.05)。结论对TIA但无已知冠心病患者,给予阿托伐他汀60 mg.d-1可降低卒中和心血管事件的发生率。

Objective To study the effects of statins on prognosis of transient ischemic attack. Methods 459 patients had transient ischemic attack （TIA） within one to six months, with low-density lipoprotein （LDL） cholesterol levels of 2.51-4.89 mmol · L^-1, and without known coronary heart disease were enrolled and treated with 60 mg of atorvastatin （220 cases） per day or placebo （239 cases）in a double-blind way. All the patients were followed-up for 1a. The primary end point was a first-episode nonfatal or fatal stroke. Results The mean LDL cholesterol level of atorvastatin group and control group after a year was 2.28 mmol · L^-1 and 3.34 mmol · L^-1, respectively（P 〈0.05）. 36 patients （ 16.4% ） receiving atorvastatin and 59 patients （24.7%） receiving placebo had a fatal or nonfatal stroke （P 〈 0.05 ）. 30 cases in the atorvastatin group had cerebral infarction and 6 cases developed hemorrhagic strokes, whereas 53 cases in the placebo group had cerebral infarction and 6 cases in which developed hemorrhagic strokes. The incidence of cerebral infarction in atorvastatin group decreased significantly in comparison with that of the placebo group（ P 〈 0.05 ）, whereas the incidences of hemorrhagic stroke did not significant deviate in two groups（ P 〉 0.05 ）. The risk of major cardiovascular events in the atorvastatin group was decreased obviously（ P 〈 0.01 ）. The overall mortality rates were similar, with 7 deaths in the atorvastatin group and 5 deaths in the placebo group. Conclusion Atorvastatin at a dose of 60 mg · d^-1 reduced the overall incidence of strokes and cardiovascular events in patients with TIA and without known coronary heart disease.