症状性颅内动脉狭窄支架成形术与内科治疗的对比研究

Comparative study of symptomatic intracranial artery stenosis stenting with medical treatment

目的比较血管内支架成形术后未规律及规律用药与单纯内科治疗对症状性颅内动脉狭窄的疗效。方法回顾性分析郑州大学第一附属医院2005年1月至2007年8月症状性颅内动脉狭窄137例,102例行支架成形术,其中术后规律用药者81例和未规律用药者21例;另35例采用常规内科治疗,随访2年,详细记录:①术后30天美国国立卫生研究院卒中量表(NIHSS)评分,降低>50%者疗效好,≤50%者疗效差;②术后短暂性脑缺血发作、卒中发病率及病死率;③改良的Rankin量表(mRS)评分,以mRS 2分以下为生存质量高,3分及以上为生存质量差。结果术后近期(30天)NIHSS评分术后规律用药者中疗效好78/81(96.3%),疗效差3/81(3.7%),术后未规律用药者中疗效好17/21(81.0%),疗效差4/21(19.0%),术后规律用药者近期疗效优于术后未规律用药者(P<0.05)。支架成形术后未规律用药者中6例(28.6%)发生卒中或死亡,术后规律用药者中1例(1.2%)发生卒中,无死亡事件发生,单纯内科治疗者中3例(8.6%)发生卒中或死亡。规范用药组卒中发生率低于未规律用药组(P<0.05),3组卒中病死率及mRS评分比较差异均无统计学意义(P>0.05)。结论血管内支架成形术是治疗症状性颅内动脉狭窄较为有效、安全的方法,其术后规律用药疗效优于未规律用药组。

Objective To compare the effectiveness between law or not of stenting postoperative drug use and medical treatment alone for the symptomatic intracranial arterial stenosis.Methods Retrospective analysis of the First Affiliated Hospital of Zhengzhou University in January 2005 to August 2007 was performed on a total of 137 patients with symptomatic intracranial arterial stenosis,102 cases accepted angioplasty stenting,there were 81 cases with the law of postoperative drug use and 21 cases not with law of drug use.The other 35 cases with conventional medical treatment,all patients were followed up for two years.Detailed records：①30 days after stenting of the U.S.National Institutes of Health Stroke Scale（NIHSS） score：the reduction 50% believed that efficacy was good,and the reduction≤50% efficacy poor;②postoperative transient ischemic attack,stroke morbidity and mortality;③mRS score,with the mRS below two points for the high quality of life,three points or more for the poor quality of life.Results Postoperative short-term（30 d） NIHSS score with the law of postoperative drug use in the good efficacy of 78/81（96.3%）,poor efficacy of 3/81（3.7%）,and not with the law of postoperative drug use in the good efficacy of 17/21（81.0%）,poor efficacy of 4/21（19.0%）,the short-term effect of the patients with law of postoperative drug use was superior to that of the patients not with law of postoperative drug use（P=0.013）.Stroke or death occurred in 6 cases（28.6%） in the patients who were not with law of postoperative drug use.There was one case（1.2%） in the patients with law of postoperative drug use who had stroke,no death occurred,three cases（8.6%） in the patients of medical treatment alone who had stroke or death.Comparing with the patients of no law of postoperative durg use,the stroke incidence of patients with law of postoperative durg use was low（P0.05）.But there was no significant difference among three groups in stroke mortality and mRS score（P0.05）.Conclusion Endovascular stenting is a more effective and safe method for the treatment of symptomatic intracranial arterial stenosis,and the law of use drug after the procedure is more effective than medical treatment alone,but not with the law of drug use after the procedure is worse than medical treatment alone.