早期强化他汀联合阿替普酶对超早期脑梗死近期疗效及CISS分型关系的研究

Analysis of short-term effect of early intensive statins combined with Alteplase on ultra early acute cerebral infarction and the relationship with CISS typing

目的研究早期强化他汀联合阿替普酶治疗超早期急性脑梗死(acute cerebral infarction,ACI)的近期临床疗效及安全性。方法将124例符合静脉溶栓ACI住院患者,随机分为两组。其中,强化组68例,阿替普酶静脉溶栓后即刻给予阿托伐他汀钙80 mg,口服14 d,此后按40 mg/d继续服用90 d,同时给予缺血性卒中的基础治疗;对照组56例,阿替普酶静脉溶栓后即刻给予阿托伐他汀20 mg/d,口服90 d,同时给予相同缺血性卒中的基础用药。按中国缺血卒中分型(Chinese ischemic stroke subclassification,CISS)病因和发病机制分型,观察分析2组患者治疗前、治疗后14 d及90 d的NIHSS评分与不良反应发生情况。结果 2组患者治疗后14 d、90 d NIHSS评分均较治疗前明显改善(强化组:4.59±0.47,3.62±0.38 vs.8.09±0.54;对照组:5.74±0.48,4.78±0.51 vs.8.94±0.51;P<0.05);强化组评分明显低于对照组(P<0.05)。CISS分型中,除心源性卒中外,强化组中其他4种病因患者的NIHSS评分减少程度均优于对照组的相同类型(P<0.05)。2组在治疗过程中均未发现严重不良反应。结论早期强化他汀联合阿替普酶治疗能安全有效改善超早期ACI不同病因患者的神经功能缺失。

Objective To analyze the short-term clinical effect and safety of early intensive statin combined with Alteplase in the treatment of ultra early acute cerebral infarction（ACI） and the relationship with Chinese ischemic stroke subclassification（CISS） typing. Methods One hundred and twenty four inpatients who were in accordance with intravenous thrombolytic ACI were randomly divided into two groups. Intensive group（n = 68） were treated with Atorvastatin（80 mg） orally for 14 d immediately after intravenous thrombolytic therapy. After that, 40 mg/d was given for 90 d, and basic treatment for ischemic stroke was given at the same time. In the control group（n = 56）, immediately after intravenous thrombolysis, Atorvastatin 20 mg/d was given orally for 90 d, and the same basic medication for ischemic stroke was given at the same time. According to the etiology and pathogenesis of CISS, the NIHSS score and incidence of adverse reactions of the two groups before treatment, 14 d and 90 d after treatment were observed. Results The NIHSS scores of both groups were significantly improved 14 d and 90 d after treatment（intensive group： 4.59±0.47, 3.62±0.38 vs. 8.09±0.54;control group： 5.74±0.48, 4.78±0.51 vs. 8.94±0.51; P〈0.05）. The scores of intensive group was significantly lower than those of control group（P〈0.05）. According to CISS, the NIHSS scores of patients of other four etiological type in intensive group was significantly lower than those of control group, except cardiogenic stroke（CS, P〈0.05）. No serious adverse reaction was found in both two groups. Conclusion Early intensive statins combined with Alteplase can safely and effectively improve the neurological deficit of patients with different causes of ACI.