不同剂量阿托伐他汀在症状性颅内动脉粥样硬化性狭窄中的影像学评估

Evaluation of the Efficacy of Different Doses of Atorvastatin in Patients with Symptomatic Intracranial Artery Stenosis

目的观察不同剂量阿托伐他汀在症状性颅内动脉粥样硬化性狭窄(intracranial arterial stenosis,ICAS)中的疗效。方法选择120例症状性ICAS患者,采用随机表法,分为低剂量组(10 mg/d)、标准剂量组(20 mg/d)和强化组(40 mg/d),每组患者各40例。临床随访52周,观察治疗前后脑血流灌注值及血管狭窄程度的变化,评价强化降脂疗效。结果三组在治疗后26周和52周,相对脑血流量(r CBF)、相对脑血容量(r CBV)较治疗前均明显升高;低剂量组和标准剂量组相对达峰时间(r TTP)与治疗前比较,均有不同程度的延长,但差异无统计学意义,强化组r TTP与治疗前比较明显缩短,差异有统计学意义;强化组平均狭窄率与治疗前相比明显降低,与治疗后低剂量组和标准剂量组相比差异也有统计学意义。结论长期他汀强化降脂治疗(40 mg/d)可以降低颅内动脉狭窄程度及提高脑血管的血流灌注。

Aim To validate the efficacy of different doses of atorvastatin for patients with symptomatic intracranial atherosclerotic stenosis（ s ICAS）. Methods 120 patients with s ICAS were enrolled and randomly divided into three groups. Patients in the three groups were given 10 mg / d,20 mg / d,and 40 mg / d of atorvastatin respectively,for one year. All patients were also given other aggressive medical therapy. Evaluation variables,including changes in degree of stenosis,and perfusion-related parameters derived from computed tomography perfusion（ CTP） imaging from baseline to one year during the study period,were used to compare the benefits of these three statin therapies. Results After one year of atorvastatin therapy,patients in the three groups had an obvious improvement of degree of stenosis,improvement of degree of stenosis was significantly better in the 40 mg / day group. Patients in the three groups had an obvious increase in relative cerebral blood flow（ r CBF） and relative cerebral blood volume（ r CBV） levels at the end of one year. However,patients in the 40 mg / day group experienced a reduction in relative time to bolus peak（ r TTP） at the end of one year while those in the other two groups showed an increase in r TTP. Conclusions Improvement of degree of stenosis,and perfusion-related parameters were all significantly better by long-term use of atorvastatin.