【摘要】 目的比较不同剂量的阿托伐他汀对初发脑梗死颈动脉彩色超声造影变化及临床预后的影响。方法选取2010年1月至2011年12月在我院神经内科住院治疗的脑梗死患者62例,使用计算机产生随机数进行简单随机化分组,脑梗死患者发病1个月内服用不同剂量的阿托伐他汀,小剂量组:20 mg/d,32例;大剂量组:40 mg/d,30例,之后两组均维持剂量20 mg/d至6个月。根据英国牛津郡社区率中项目(OCSP)分型将患者分为腔隙性梗死(16例)、完全前循环梗死(15例)、部分前循环(16例)和后循环梗死(15例)4个亚组,应用超声造影观察患者发病时及6个月后的颈动脉病变情况,并应用美国国立卫生院神经功能缺损评分(NIHSS)了解梗死后1、3及6个月患者的功能状态,使用两独立样本t检验比较两组结果。结果发病时及梗死6个月后超声造影显示颈动脉内膜中层厚度变化,两组间差异无统计学意义(t右侧=-0.627,P>0.05;t左侧=0.305,P>0.05);梗死后1、3个月的NIHSS差值,两组间差异无统计学意义(t=1.514,P>0.05;t=1.468,P>0.05);梗死后6个月大剂量组NIHSS差值低于小剂组(t=2.008,P=0.049)。结论脑梗死发病1个月内服用较大剂量的阿托伐他汀在较长时间(6个月)时可改善脑梗死预后,但颈动脉彩色超声造影未能同时反映该临床变化。更多还原

【Abstract】 Objective To assess the change in contrast-enhanced ultrasound imaging and clinical prognosis of different dose of atorvastatin administrated after new onset ischemic stroke. Methods A total of 62 patients with new onset ischemic stroke,diagnosed in the Third Affiliated Hospital of Guangzhou Medical University from Jan 2010 to Dec 2011 were randomized into an atorvastatin 20 mg/d (32 cases) and 40 mg/d (30 cases) groups. One month later both groups were given maintenance dose of 20 mg/d until the sixth month. According to Oxfordshire Community Stroke Project (OCSP) classification,they were divided into lacunar infarcts (16 cases),total anterior circulation infarcts (15 cases),partial anterior circulation infarcts (16 cases) and posterior circulation infarcts (15 cases). The new onset contrast-enhanced ultrasound imaging of carotid artery was performed on admission and a second check the sixth month later. Neurological function assessment was performed using the National Institutes of Health Stroke Scale( NIHSS) in admission month from diagnose and repeated in the third and sixth months. After that,they were analyzed with two independent sample t-test. Results There was no difference in the carotid intima-media thickness in the contrastenhanced ultrasound imaging between the two groups in the first and sixth months (right: t =- 0. 627,P >0. 05; left: t = 0. 305,P > 0. 05). The result was similar in the NIHSS score one month and three months later (t =1.514,P >0.05; t=1. 468,P >0.05). However,the NIHSS score was significantly lower in high-dose group than that in low-dose group in the sixth month (t= 2.008,P=0.049). Conclusions High dose (40 mg/d) of atorvastatin in one month can improve prognosis of new onset ischemic stroke. However,the contrast-enhanced ultrasound can not show the improvement during the first,third and sixth months.更多还原