多社区颈动脉斑块人群干预治疗对斑块逆转及缺血事件发生的评价

Evaluation of carotid artery plaques reversal and ischemic events after the carotid therosclerotic plaques of multiple communities crowd by integrated intervention treatment

目的:通过长期对颈动脉粥样硬化斑块人群采取控制斑块、改善高危因素等综合干预,观察斑块面积、颈部动脉血管内至中层厚度(IMT)、斑块性质的改变及对缺血性卒中发生的影响。方法:将336例颈动脉粥样硬化斑块患者随机分为干预组和对照组。2组均接受低盐、低脂、低糖饮食控制。干预组在饮食控制基础上,口服阿托洛伐他汀20mg每日1次,连续12个月;同时给予控制血糖、降低同型半胱氨酸。结果:综合干预治疗12个月后,(1)颈动脉IMT、硬化斑块面积、性质与自身前和对照组对比有显著差异(均P<0.05)。(2)干预组总体卒中发生减少,与对照组有显著差异(P<0.05)。(3)对于颈动脉重度狭窄(狭窄率>90%),干预治疗后与对照组同等患者在缺血事件发生上,无显著差异(P>0.05);且降低血浆同型半胱氨酸对该类患者卒中的发生率没有显著关联(P>0.05)。结论:(1)对颈动脉硬化斑块人群长期给予调酯、降糖、控制血浆同型半胱氨酸等治疗,可稳定甚至缩小颈动脉粥样硬化斑块,达到斑块逆转,在二级预防中有助于预防卒中的发生。(2)而对于颈部动脉硬化斑块形成导致血管重度狭窄,狭窄率>90%的患者,综合干预不能降低卒中发生的风险。

Objective：To improve risk factors etc comprehensive interference and observe the effect of ischemic stroke on the change of plaques properties, build-up area and carotid artery intima-media thickness（IMT） throuth long-term carotid atherosclerotic plaques of people take control paques. Methods：336 cases of carotid atherosclerotic plaque patients were randomly divided into intervention group and the control group. Both groups to accept low salt, low fat, low carbohydrate diet control. Intervention group based on the diet control, oral atorastatin 20 mg daily 1 times, 12 consecutive months; Meanwhile give control blood sugar, lowering homocysteine. Results：Integrated intervention after 12 months, （1） the IMT, property and area of the atherosclerotic plaque, there were significant differences compared with their own before and the control group （P 0.05）. （2） intervention group overall stroke reduce, there were significant differences with the control group （P 0.05）. （3） for carotid artery severe strictures （Stricture rate 90%） , Contrast ischemic stroke events of the control group after intervention treatment and the control group, there were no significant difference （P 0.05）. And the lowering of plasma homocysteine projected to the incidence of stroke patients with no significant correlation （P 0.05）. Conclusion：（1） for the atherosclerotic plaques crowd give long-term control blood sugar, lowering plasma homocysteine and low-fat diet, Can achieve the purpose of stable and narrowing the plaques,In the secondary prevention helps prevent the occurrence of stroke. （2） for the patients with atherosclerotic plaques formation cause blood vessels to severe stricture （Stricture rate 90%）, narrow rate 90% of, comprehensive interference dould not reduce the risk of stroke.