最佳LDL-C目标水平对症状性颈动脉狭窄患者发生终点事件的长期随访及超声评价

The long term follow up and evaluation by ultrasound in research of the best target lipid levels in patients with symptomatic carotid artery stenosis

目的研究最佳目标血脂水平预防症状性颈动脉狭窄患者脑梗死发生和复发、心脏事件的效果,并进行安全性观察及超声评价。方法 初发的症状性颈动脉狭窄患者337例,随机分为治疗组236例,对照组101例。治疗组将LDL-C调治在1.82～2.10 mmol/L范围内,对照组控制LDL-C<1.82 mmol/L。随访3年、5年后对其功能健康水平、终点事件、超声学参数分别进行评定。结果 3年、5年后治疗组功能健康水平均高于对照组(P<0.01)。脑梗死发生和复发、心脏事件及5年总病死率均低于对照组(P<0.05)。治疗3年和5年超声复查斑块治疗组均较对照组稳定(P<0.05),颈动脉IMT及斑块指数均明显低于对照组(P<0.01),颈动脉PSV、SR、PI、EDV、RI与对照组比较差异有统计学意义(P<0.05,P<0.01)。结论将血脂调治在1.82～2.10 mmol/L的最佳目标血脂水平对预防症状性颈动脉狭窄患者脑梗死发生及复发效果显著;利用颈动脉彩色超声对治疗效果进行评价便捷、可靠,重复性好,在症状性颈动脉狭窄的二级预防中具有很好的指导作用。

Objective To stduy the effect,security and ultrasound evaluation of the best target lipid levels for the prevention of cerebral infarction and recurrence in symptomatic carotid artery stenosis patients.Methods A total of 337 incipient patients who suffered from symptomatic carotid artery stenosis were randomly divided into treatment group（236 cases） and contral group（101 cases）.The treatment group modulated the level of LDL-C in range of 1.82 ~ 2.10 mmol/L.The control group modulated the level of LDL-C less than 1.82 mmol/L.The functional health,endpoint event and ultrasonic indexes after three years,five years treatment were compared between the two groups.Results The treatment group had higher functional health than that in the control group after 3 and 5 years follow up（P 0.01）.In the treatment group,the occurrence and recurrence of cerebral infarction,cardiac events were significantly lower than those in the control group（P 0.05）.The 5 years mortality rate in the treatment group were lower than that in the control group（P 0.05 ）.The plaque was more steady than that of control group through the ultrasound re-examination after 3 and 5 years follow up（P 0.05）.The carotid IMT and plaque index in treatment group were lower than those in the control group（P 0.01 ）.It showed statistical difference between two groups in the indexes of PSV,SR,PI,EDV and Rl（P 0.05,P 0.01）.Conclusion For the patients with symptomatic carotid artery stenosis,modulating the lipid level in the range of 1.82～2.10 mmol/L could effectively reduce the incidence of cerebral infarction and recurrence.Furthermore,the carotid ultrasound was a convenient and reliable method to evaluate the therapeutic effect.