易损颈动脉斑块强化他汀治疗与支架术治疗在TIA中的对照研究

Comparative study on the therapeutic effects of intensive statins and stenting in treatment of vulnerable carotid plaques of patients with TIA

目的探讨易损颈动脉斑块强化他汀类药物治疗与支架术治疗的效果。方法短暂性脑缺血发作(TIA)合并颈动脉易损斑块患者100例,采用随机数字表法将患者随机分为药物治疗组(n=52)和支架治疗组(n=48),药物治疗组给予强化他汀类药物治疗,支架治疗组给予支架成形术,观察2组治疗前后血脂[胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]、颈动脉内中膜厚度(IMT)、斑块面积等。结果药物治疗组治疗后TC、TG和LDL-C,明显低于支架治疗组(P<0.05),而HDL-C高于支架治疗组(P>0.05);药物治疗组治疗后IMT和斑块面积明显低于支架治疗组(P<0.05);药物治疗组治疗后颈动脉狭窄率,明显高于支架治疗组(P<0.05);药物治疗组和支架治疗组治疗期间并发症发生率比较差异无统计学意义(P>0.05);药物治疗组和支架治疗组再次TIA发生率比较,差异无统计学意义(P>0.05)。结论强化他汀类药物治疗易损颈动脉斑块有较好的效果,尽管其治疗对颈动脉狭窄率改善不如支架治疗明显,但对稳定斑块、血脂改善及部分无法进行介入手术的患者而言,值得临床推广使用。

Objective To investigate the therapeutic effects of intensive statins and stenting in treatment of vulnerable carotid plaques of patients with TIA. Methods One hundred patients with transient ischemic attack（TIA） complicated by vulnerable carotid plaques who were admitted and treated in our hospital from July 2015 to February 2017 were enrolled in the study. According to random digital table method,these patients randomly divided into drug treatment group（n = 52） and stenting treatment group（n = 48）. The patients in drug treatment group were treated by intensive statins,however,the patients in stenting treatment group were treated by stent plasty. The changes of levels of TC,TG,LDL-C, HDL-C, carotid intima-media thickness（IMT） and plaque area before and after treatment were observed and compared between two groups.Results After treatment the levels of TC,TG and LDL-C in drug treatment group were significantly lower than those in stenting treatment group（P〈 0. 05）,however the HDL-C levels in drug treatment group were significantly higher than those in stenting treatment group（P〈 0. 05）. Moreover the IMT and plaque area in drug treatment group were significantly lower than those in stenting treatment group（P〈 0. 05）,but the incidence rate of carotid stenosis in drug treatment group was significantly higher than that in stenting treatment group（P〈 0. 05）. In addition there were no significant differences in the incidence rate of complication during treatment and incidence rate of TIA between two groups（P〉0. 05）. Conclusion Intensive statins in treatment of vulnerable carotid plaques of patients with TIA can obtain satisfactory therapeutic effects,though its therapeutic effects in improving carotid artery stenosis are inferior to those by stenting,for the patients who can not be treated by stenting,which is worth using in clinical practice.