依折麦布联合阿托伐他汀治疗对伴颅内动脉粥样硬化轻型卒中患者疗效和安全性

Effect of Ezetimibe combined with Atorvastatin on the short-term prognosis and recurrence of mild stroke and intracranial atherosclerosis

目的探讨依折麦布联合阿托伐他汀治疗对伴颅内动脉粥样硬化(intracranial atherosclerosis,ICA)的轻型缺血性脑卒中(mild ischemic stroke,MIS)患者的短期预后及复发的有效性和安全性。方法收集伴ICA的MIS患者,根据不同方案进入单独应用阿托伐他汀20 mg/d对照组、联合应用依折麦布10 mg/d及阿托伐他汀20 mg/d治疗组,采用改良Rankin量表(modified rankin scale,mRS)评估患者90 d预后,mRS≤2分为预后良好,>2分为预后不良;应用高分辨率磁共振管壁成像(high resolution magnetic resonance vessel wall imaging,HRMR-VWI)评估患者治疗前后的ICA斑块负荷;进行12个月的随访评估复发的情况。结果共纳入212例患者,治疗组74例,对照组138例。两组的基线资料、90 d的短期预后对比差异无统计学意义(P>0.05)。治疗组180 d的低密度脂蛋白胆固醇和斑块负荷低于对照组,差异有统计学意义(P<0.05);治疗组死亡1例,死亡于脑出血,对照组死亡1例,死因为急性冠脉综合征,两组间病死率比较差异无统计学意义(P>0.05);治疗组复发2例,对照组复发17例,两组复发率差异有统计学意义(P<0.05)。结论联合应用依折麦布和阿托伐他汀治疗伴ICA的MIS可减轻患者ICA斑块负荷,并降低1年内的复发率,具有较高的安全性。

Objective the short-term prognosis and recurrence of mild ischemic stroke(MIS)and intracranial atherosclerosis(ICA).Methods Hospital of Nantong University from January 2017 to December 2019 were included and divided into control group and treatment group,the former treated only with Ezetimibe and the latter with Ezetimibe combined with Atorvastatin.The Modified Rankin Scale(mRS)was used to evaluate the prognosis of patients in both groups at 90 days.MRS≤2 was regarded as good prognosis and>2 as poor prognosis.The plaque burden of ICA was assessed by high resolution magnetic resonance vessel wall imaging(HRMR-VWI)before and 180 days after treatment in both groups.All the patients were followed up for 12 months after discharge to evaluate the recurrence of ischemic stroke within 12 months.Results the control group.There was no significant difference in demographic and baseline data between the two groups(P>0.05).There was no significant difference in terms of the short-term prognosis of 90 days,while the lowdensity lipoprotein cholesterol and plaque burden of HRMR-VWI were significantly lower 180 days later.One case died of cerebral hemorrhage in the treatment group,and 1 case died of acute coronary syndrome in control group,with no statistical significance in the mortality between the groups(P>0.05).There was significant difference in the occurrence rate between the groups(2.7%vs.12.3%,P<0.05).Conclusion vastatin is effect in reducing the plaque burden of ICA and the recurrence rate of cerebral infarction within one year in patients with MIS and ICA,and its safety is high.