联合血管重建术配合辛伐他汀治疗缺血型烟雾病的临床研究

Clinical observation of combined bypass surgery with simvastatin therapy on patients with ischemic moyamoya disease

目的探讨联合血管重建术配合辛伐他汀治疗缺血型烟雾病的临床疗效。方法选取2007年6月至2013年12月在郑州大学人民医院接受联合血管重建术治疗的缺血型烟雾病患者63例,其中31例接受联合血管重建术常规药物者作为对照组,另32例在对照组基础上配合辛伐他汀治疗作为观察组。采用CT血管造影(CTA)、脑血流灌注及神经功能评分评估随访分析两组烟雾病患者的临床疗效。两组均数比较采用独立样本t检验,计数资料采用R×C表χ2检验。结果两组患者治疗后1、6、12个月的改良Rankin量表(mRS)指数均较治疗前明显降低(t=2.012,P=0.049;t=3.465,P=0.001;t=4.426,P=0.000;t=3.668,P=0.001;t=5.026,P=0.000;t=6.062,P=0.000),并且观察组较对照组降低更为显著(t=2.702,P=0.042;t=2.069,P=0.043;t=2.028,P=0.047)。术后6个月脑血流量及脑血容量等指标均较术前一定改善,术后两组脑血流量及脑血容量差异有统计学意义(t=0.705,P=0.009;t=2.329,P=0.023),而达峰时间及平均通过时间差异无统计学意义(均P>0.05)。观察组血管重建情况优于对照组(χ2=42.67,P=0.033)。整个治疗过程中,所有患者均未出现明显不良反应。结论缺血型烟雾病联合血管重建配合辛伐他汀治疗可显著改善脑缺血区域血运,促进烟雾病患者神经功能恢复。

Objective To evaluate clinical efficacy of combined bypass surgery （ CBS ） with simvastatin on patients with ischemic moyamoya disease. Methods Sixty-three patients with ischemic moyamoya disease underwent neurosurgical treatment in Department of Neurosurgery, People＇ s Hospital of Zhengzhou University were enrolled and analyzed retrospectively,in which 31 cases received CBS as control group, while the other 32 cases received the same surgery with simvastatin treatment as the observation group. The clinical efficacy was compared between the two groups by computed tomography angiography（CTA） and computed tomography perfusion （CTP） and neurological score. The two groups of mean differences were compared by independent t-test, chi-square test was applied to count data R × C table. Results Vascular remodeling rate and cerebral blood flow perfusion were better than pre-operation both in control group and observation group. There were no statistical differences in modified Rankin scale（mRS） score between the two group before the treatment （P 〉 0. 05 ）. The mRS of two group both showed a trend of decreasing after the therapy of 1 month,6 months,12 months（t =2. 012,P =0. 049;t =3.465,P =0. 001 ;t =4. 426,P =0. 000; t = 3. 668, P = 0. 001 ; t = 5. 026, P = 0. 000 ; t = 6. 062, P = 0. 000）. At the same point in time, mRS score of observation group was significantly lower than in control group（ t = 2. 702, P = 0. 042 ; t = 2. 069, P = 0. 043 ; t =2. 028 ,P = 0. 047）. The differences of cerebral blood flow and cerebral blood volume were statistically significant （ t = 0. 705,P = 0. 009 ; t = 2. 329,P = 0. 023 ）. Vascular remodeling in observation group was better than that in the control group（χ^2 =42. 67 ,P =0. 033） ,and there were no statistically significant difference in the time to peak and mean transit time（ all P 〉 0. 05 ）. No evident adverse reaction was observed throughout the treatment process. Conclusion CBS with simvastatin treatment can evidently improve patients＇ blood supply of cerebral ischemia area,which can also promote recovery of neural function in patients with ischemic moyamoya disease.