阿托伐他汀联合氯吡格雷对脑梗塞二级预防患者颈动脉斑块的影响

Effects of Atorvastatin Combined with Clopidogrel on Carotid Plaque in Patients with Secondary Prevention of Cerebral Infarction

对比分析不同他汀类药物联合氯吡格雷对缺血性卒中二级预防患者颈动脉斑块及临床疗效的影响,探讨其药理作用机制。选取保定市第四中心医院2017年1月—2019年5月收治的148例行二级预防的脑梗塞患者为研究对象,采用随机信封法将其分为A、B两组,每组74例。两组均口服氯吡格雷,A组联合使用阿托伐他汀,B组联合使用瑞舒伐他汀,两组均连续给药6个月后进行疗效评价。研究显示:经治疗6个月后A、B两组患者的颈动脉内中膜厚度(IMT)均较治疗前明显缩小(P<0.05)。治疗6个月后两组斑块面积均较治疗前明显缩小(P<0.05),A组斑块面积较B组降幅更大,A组治疗后斑块面积明显小于B组(P<0.05)。治疗后两组不稳定性斑块数目、斑块Crouse积分和颈动脉狭窄率均较治疗前明显下降(P<0.05),但差异无统计学意义(P>0.05)。治疗后两组血液流变学指标和血脂水平均较治疗前改善(P<0.05),组间差异均无统计学意义(P>0.05)。治疗1个月、3个月、6个月后A、B两组血小板聚集率均明显下降(P<0.05),但组间无统计学意义(P>0.05)。A组出现肝酶升高1例,肌酶升高或肌肉疼痛2例,不良反应发生率为4.05%;随访卒中复发7例,占9.46%。B组出现肝酶升高5例,肌酶升高或肌肉疼痛6例,不良反应发生率为14.86%,随访复发6例,占8.11%。A组不良反应发生率低于B组,差异有统计学意义(P<0.05),复发率高于B组,但差异均无统计学意义(P>0.05)。结果表明阿托伐他汀联合氯吡格雷用于脑梗塞的二级预防能有效缩小颈动脉斑块面积,降低颈动脉内膜中层厚度,减轻动脉狭窄程度,改善血液流变学和血脂水平。阿托伐他汀或瑞舒伐他汀联合氯吡格雷的脑梗塞二级预防作用无明显差异,但在缩小颈动脉斑块面积方面选用阿托伐他汀治疗获益更大,且安全性较好。

The purpose of this paper is to comparatively analyze the effects of different statins combined with clopidogrel on carotid plaque and clinical efficacy in secondary prevention of ischemic stroke,and to explore its pharmacological mechanism.128 patients with secondary prevention of cerebral infarction admitted to Baoding fourth central hospital from January 2017 to May 2019 were selected as the research objects,and were divided into group A and group B using the random envelope method,with 74 cases in each group.Both groups were given oral clopidogrel,group A was combined with atorvastatin,while group B was combined with rosuvastatin.Both groups were given continuous administration for 6 months before the efficacy evaluation.After 6 months of treatment,the IMT of patients in groups A and B were significantly reduced compared with that before treatment(P<0.05).After 6 months of treatment,the plaque area of the two groups was significantly smaller than that before the treatment(P<0.05).The plaque area of group A was significantly smaller than that of group B(P<0.05).After treatment,the number of unstable plaques and carotid artery stenosis rate in the two groups were significantly lower than before treatment(P<0.05),and hemorheological indexes were improved compared with before treatment(P<0.05).There was no statistically significant difference between two groups(P>0.05).After 1,3,and 6 months of treatment,the platelet aggregation rate of two groups decreased significantly(P<0.05),but there was no statistical significance between two groups(P>0.05).In group A,1 case had elevated liver enzymes and 2 cases had elevated muscle enzymes or muscle pain.The adverse reaction rate was 4.05%.7 cases of stroke recrudesced in follow-up period,accounting for 9.46%.In group B,there were 5 cases of elevated liver enzymes,6 cases of elevated muscle enzymes or muscle pain,the incidence of adverse reactions was 14.86%,and 6 cases of recurrence were followed up,accounting for 8.11%.The incidence of adverse reactions in group A was lower than that in group B,the difference was statistically significant(P<0.05).The recurrence rate in group A was higher than that in group B,but the differences were not statistically significant(P>0.05).The results show that atorvastatin combined with clopidogrel for the secondary prevention of cerebral infarction can effectively reduce the carotid artery plaque area,the thickness of the carotid artery intima-media,and the degree of arterial stenosis,and improve blood rheology and blood lipid levels.Atorvastatin or rosuvastatin combined with clopidogrel has no significant difference in the secondary preventive effects of cerebral infarction,but the use of atorvastatin to reduce the area of carotid artery plaque has greater benefits and better safety in treat ment.