摘要
目的探讨普罗布考+阿司匹林+他汀类药物(PAS)联合应用与颈动脉支架置入术(CAS)治疗症状性颈动脉重度狭窄的近期疗效差异。方法回顾性分析2012年12月至2014年6月收治的492例症状性颈动脉重度狭窄患者的临床资料,其中采用PAS治疗(PAS组,366例)和采用CAS治疗(CAS组,126例)。评估两组患者出院后1年内严重临床不良事件(非致命性脑梗死、同侧无症状性脑卒中、短暂性脑缺血发作)发生率、次要临床不良事件(DSA示血管再狭窄较前增加>10%)发生率以及血清血脂水平变化。结果 CAS组非致命脑卒中发生率(2.3%,3/126)和短暂脑缺血发作发生率(7.9%,10/126)均明显低于PAS组[分别为(9.6%,35/366)和(15.3%,56/366);P<0.05],但是CAS组次要临床事件发生率(34.1%,43/126)明显高于PAS组(15.0%,55/366;P<0.01)。PAS组同侧无症状性脑卒中发生率(9.3%,34/366)和CAS组(4.0%,5/126)无统计学差异(P>0.05)。PAS组复诊时血清高密度脂蛋白-胆固醇(HDL-C)水平较基线水平明显增高(P<0.01),而血清低密度脂蛋白-胆固醇(LDL-C)、总胆固醇、甘油三酯水平较基线水平明显降低(P<0.01)。CAS组复诊时血清HDL-C、LDL-C、总胆固醇、甘油三酯水平和基线水平无明显差异(P>0.05)。结论 CAS治疗相比较PAS药物强化治疗能够明显降低患者近期严重不良事件的发生率;但是,PAS药物强化治疗能够在一定程度上降低血脂水平。
Objective To compare the clinical effect of intensive therapy with probucol, aspirin and statin （PAS） on severe symptomatic carotid artery stenosis with that of carotid artery stenting （CAS）. Methods Of 492 patients with severe symptomatic carotid artery stenoses, 366 were the intensively treated by PAS and 126 by CAS. The occurrent rates of the adverse clinical events （ACE） and blood lipid levels including high density lipoprotein cholesterol （HDL-C）, low density lipoprotein cholesterol （LDL-C）, total cholesterol （TC） and triglyceride（TG） were compared between both the groups 1 year after discharging from the hospital. Results The occurent rate （14.3%） of serious ACE was significantly lower in the CAS group than that （34.4%） in PAS group （P〈0.05） and the occurent rate （15.0%） of the secondary clinical events （restenosis 〉10%） is significantly lower in PAS group than that （34.i%） in the CAS group （P〈O.05）. The levels of LDL-C, TC and TG were significantly lower and the level of HDL-C was significantly higher after the treatment than those before the treatment in PAS group （P〈0.01）, in which the levels of LDL-C TG and TC were significantly lower than those and the leve]~ of HDL-C was significantly higher than that in CAS group after the treatment （P〈0.01）. There was insignificant difference in the level of the blood lipid between before and after the treatment in CAS group （P〉0.05）. Conclusions CAS may significantly reduce the incidence of severe ACE compared with the intensive therapy with PAS, which may significantly reduce the levels of LDL-C, TL and TG and increase the level of HDL-C, and has a good effect on the prevention of the progression of vascular stenosis.
出处
《中国临床神经外科杂志》
2015年第12期727-729,共3页
Chinese Journal of Clinical Neurosurgery
