【作者】 夏章勇； 胥庆华； 杨华； 曲怀谦； 殷勤； 徐格林；

【Author】 XIA Zhangyong,XU Qinghua,YANG Hua,et al.Department of Neurology,The First People’s Hospital of Liaocheng,Shandong,Liaocheng 252000,China

【机构】 山东省心脑血管病微创治疗工程技术研究中心 山东聊城市人民医院神经内科； 山东聊城市第三人民医院神经内科； 南京大学神经病学研究所； 南京军区南京总医院神经内科；

【摘要】 目的评价症状性颈动脉完全闭塞患者介入治疗和药物治疗的效果,观察干预后血管事件的随访结果。方法 62例症状性颈动脉完全闭塞患者意向性分为介入组和药物组。介入组21例患者给予颈动脉闭塞血管再通术,药物组41例患者给予阿司匹林、氯吡格雷及他汀类药物治疗。随访主要终点事件为发病2年时功能预后(mRS评分);次要终点事件为血管事件的发生。结果介入组患者在随访3月、6月、1年及2年时,mRS平均秩次均低于药物组,差异有统计学意义。介入组和药物组患者再发血管事件的中位数时间分别为(17.42±1.20)个月(95%CI 15.07～19.76)、(19.43±1.51)个月(95%CI 16.48～22.38),Kaplan-Meier分析表明差异无统计学意义。多因素Cox分析表明两组患者血管事件再发的独立危险因素主要包括吸烟(RR=3189,95%CI 1.020～9.968:P=0.046)、糖尿病(RR=2.717,95%CI 1.113～6.631;P=0.028)及基线NIHSS(RR=2.984,95%CI 1.049～8.485;P=0.737),而治疗方案(介入治疗和药物治疗)不是血管事件的独立影响因素(RR=1.191,95%CI 0.430～3.296;P=0.737)。结论对于症状性颈动脉完全闭塞患者介入治疗较药物治疗能获得更好的功能预后,但随访2年时未能减少血管事件的发生;吸烟、糖尿病及基线NIHSS是其血管事件再发的独立危险因素。更多还原

【Abstract】 Objective To evaluat the effects of antery-intervention therapy and drug treatment in the patients with symptomatic carotid artery total occlusion,and observe the follow-up results of cerebrovascular events after clinical interference.Methods According to patients intention,62 patients with symptomatic carotid artery total occlusion were divided into two groups: antery-intervention therapy group and drug treatment group.In the antery-intervention therapy group, 21 patients are revagcularization by endovascular intervention.In the drug treatment group,41 patients were given with aspirin,clopidogrel and statins.The major end-point outcome of follow-up survey was the 2-year functional prognosis evaluated by modified Rankin Score(mRS),while the minor one was the cardiovascular events.Results For 3 month,6 month,9 month,1 year and 2 year follow up,the antery-intervention therapy group’s all mRS average ranks were lower than drug treatment group,the differences were statistically significant.The median time of recurrence of cardio-cerebrovascular events in the two groups was funher investigated in 17.42±1.20 month (95%CI 15.07～19.76),19.43±1.51month(95%CI 16.48~22.38),Kaplan-Meier analysis showed no significant difference.Survival analysis with Cox showed independent factors of cardio-cerebrovascular events c were smoking(RR=3.189,95%CI 1.020~9.968;P=0.046),diabetes (RR=2.717,95%CI 1.113-6.631;P=0.028),and baseline NIHSS(RR=2.984,95%CI1.049-8.485; P=0.737),but treatment methods(antery-intervention therapy and drug treatment) were not independent factors(RR=1.191,95%CI 0.430-3.296;P=0.737).Conclusion Antery-intervention therapy is superior pure drug therapy in achieving better functional prognosis.However the 2 years follow up,the antery-intervention therapy can not reduce occurence of the cardio-cerebrovascular events.Smoking,diabetes and baseline NIHSS are independent factors of recurrence of cardio-cerebrovascular events.更多还原