强化降脂对症状性颅内动脉狭窄患者预后的前瞻性研究

Prospective Studies on Prognosis of Patients with Symptomatic Intracranial Artery Stenosis Treated by Intensive Statin Therapy

目的:观察强化降脂在治疗症状性颅内动脉狭窄患者中的疗效及预后。方法:选择120例症状性颅内动脉狭窄患者,按照随机化原则分为低剂量他汀治疗(low-dose atorvastatin therapy,LAT)组,标准剂量他汀治疗(standard-dose atorvastatin therapy,SAT)组和强化他汀治疗(intensive-dose atorvastatin therapy,IAT)组,每组40例,分别给予口服阿托伐他汀10、20和40 mg/d,临床随访52周,记录用药前、用药后26周及52周的低密度脂蛋白胆固醇/高密度脂蛋白胆固醇(LDL-C/HDL-C)比值和临床终点事件发生率,评价不同剂量阿托伐他汀临床疗效。结果:治疗随访期间,3组不良反应比较无统计学差异;IAT组LDL-C/HDL-C比值显著低于LAT和SAT组,差异有统计学意义;治疗后52周时LAT、SAT及IAT三组脑血管终点事件发生率分别为26.3%、13.5%和5.4%,LAT组与IAT组比较差异有统计学意义。结论:阿托伐他汀(40 mg/d)强化降脂治疗可以降低LDL-C/HDL-C比值,降低脑血管事件发生率。

Objective To observe the efficacy and prognosis of intensive statin therapy for patients with symptomatic intracra- nial atherosclerotic stenosis（SICAS）. Methods Total 120 patients with sICAS were enrolled and randomly divided into three groups（ n =40） including low-dose atorvastatin therapy group（ LAT group, 10 mg/d）, standard-dose atorvastatin therapy group（ SAT group,20 mg/d）, and intensive-dose atorvastatin therapy group （IAT group,40 mg/d）. All patients were also given other routine medical therapy and followed up for 52 weeks. The ratio of LDL-C to HDL-C and the incidence rate of clinical end-points events were recorded at three time points including before administration, 26 weeks after administration and 52 weeks after administration. The clinical efficacy of three groups were comparatively analyzed. Results The incidence rate of adverse reactions had no significant difference among three group during the treatment and following-up period. The ratio of LDL-C to HDL-C of IAT group was obviously lower than those of LAT and SAT groups. After 52 weeks of treatment, the incidence rate of cerebrovascular end-points events was 26.3%, 13.5% and 5.4% in LAT, SAT and IAT groups, re- spectively, and the difference between LAT and IAT group was more obvious. Conclusion Atorvastatin could better decrease the ratio of LDL-C to HDL-C and incidence rate of clinical end-point events with an intensive dosage of 40 mg/d.