摘要
目的探讨普罗布考联合阿托伐他汀治疗对脑梗死患者预后的影响。方法急性脑梗死患者120例,入院查颈动脉彩超提示存在动脉粥样硬化(AS)斑块,男性68例,女性52例,年龄39～84岁,平均年龄74±15岁。随机分为两组,第一组男性35例,女性25例,年龄39～83岁,平均年龄73±16岁,予阿托伐他汀(20mg.d-1);第二组男性33例,女性27例,年龄41～84岁,平均年龄76±18岁,予阿托伐他汀(20mg.d-1)、普罗布考(500mg.d-1)联合治疗。两组患者分别于治疗前、治疗后6个月(6M)、12个月(12M)、24个月(24M)进行NIHSS评分、改良Rankin量表(mRS)评定患者临床预后,mRS 0～2分为预后良好,3～6分为预后不良,并记录脑梗死复发情况,进行分组分析。结果 (1)两组各时间点NIHSS评分情况:第一组治疗后6M、12M、24M的NIHSS评分分别为5.83±3.25、4.96±2.61、5.02±3.11,较治疗前9.42±3.38有不同程度下降,其中12M时下降较明显(P<0.01);第二组治疗后6M、12M、24M的NIHSS评分分别为6.01±3.74、3.24±2.08、3.17±2.52,治疗后6M较治疗前NIHSS评分(9.89±3.67)有所下降(P<0.05),治疗后12M、24M较治疗前下降更明显(P<0.01),且治疗后12M、24M的NIHSS评分也低于治疗后6M(P<0.05);两组相比,治疗后24M第二组较第一组NIHSS评分下降更显著(P<0.05);(2)两组各时间点mRS情况:第二组治疗后24M预后良好率为90.7%,较该组治疗后6M的72.2%有所提高,且高于第一组治疗后同时间点的预后良好率(76.8%),P<0.05,其余各时间点两组mRS评价差异无统计学意义;(3)两组24M脑梗死复发率分别为28.6%、22.2%,两组比较,各时间点脑梗死复发率差异无统计学意义。结论稳定斑块是治疗脑梗死动脉粥样硬化的重要而长远的策略,普罗布考联合阿托伐他汀可从多方位、多靶点的抗AS作用,从而改善脑梗死后神经功能及生活质量,其在脑梗死二级预防中的作用有待于扩大样本,进一步完善随访,以获得更全面、更具有代表性的资料。
Objective To explore the effect of Probucol combinding with Atorvastatin on the prognosis of ischemic infarction patients. Methods 120 acute cerebral infarction patients, who had atherosclerotic plaques examined by carotid artery color Doppler ultrasound at the time of admission, including 68 males and 52 females and the average age were 74 ± 15 yeares （39-84 years）. They were divided into 2 groups randomly. Group 1 comprised 35 males and 25 females whose average age were 73 ~ 16 yeares （39-83 years） and received Atorvastatin（20mg/L） ; Group 2 comprised 33 males and 27 females whose agerage age were 76 ± 18 yeares （41-84 yeares） and received Atorvastatin （20mg/L） combinding with Probucol（500mg/L）. The National Institutes of Health Stroke Scale （NIHSS） scores and the modified Rankin Scores （mRS） were used to evaluate the clinical prognosis of the two groups patients respectively before and 6 months（6M） and 12 months （12 M） after treatment, mRS 0-2 was evaluated as favorable prognosis and 3-6 as unfavorable prognosis. We recorded the relapse of stroke and analyze data by groups.Results （ 1 ） NIHSS scores in two groups at 4 time points ： The NIHSS scores in Group 1 at 6M, 12M and 24M were 5.83 ± 3.25,4.96 ±2.61 and 5.02 ± 3.11 respectively and decreased in different degree compared with that before treatment （9.42 ± 3.38 ） especially at 12M （P〈0.01） ; The NIHSS scores in Group 2 at 6M, 12M and 24M were 6.01 ±3.74,3.24 ±2.08 and 3.17 ±2.52 respectively. NIHSS score at 6M after treatment decreased than that of before treatment （9.89 ± 3.67 ） （ P 〈 0.05 ）, much more decreased arose at 12M and 24M after treatment （ P 〈 0.01 ）. The NIHSS scores at 12 M and 24M were both lower than that at 6M after treatment （ P 〈 0.05 ） ; The NIHSS score at 24M in Group 2 was lower much than that in Group 1 （ P 〈 0.05 ）. （ 2 ） mRS in two groups at 4 time points ： The rate of favorable prognosis at 24M after treatment in Group 2 was 90.7%. It was higher than that at 6M after treatment（72.2% ） in Group 2 and also higher than that at 24M in Group 1 （76.8%） （P 〈0.05）. There were no difference among the other time points in two groups of mRS. （3）The rate of relapse of stroke in two groups at 24M after treatment are 28.6% and 22.2% respectively, There are no difference at every time points between the two groups of the rate of relapse. Conclusion Stablizing vulnerable plaque is an important and long-term strategy in treatment of atheroselerotic plaques in stroke patients. Probucol combinding with Atorvastatin could counteract-AS through through muhi - directions and multi-targets. The treatment could better the neurological functions and life qualities after stroke by secondary prevention. More complete and more representative data should be achieved by expandesample and further perfecting follow-up.
出处
《脑与神经疾病杂志》
2012年第6期420-423,共4页
Journal of Brain and Nervous Diseases
基金
上海市卫生局科研课题计划资助项目(2007124)
关键词
脑梗死
普罗布考
阿托伐他汀
预后
Cerebral infarction
Probucol
Atorvastatin
Prognosis.
