摘要
目的调查脑梗死患者二级预防中他汀类药物的应用现况并分析其疗效。方法随机选取300例脑梗死患者，按照是否服用他汀类药物分为药物治疗组91例与对照组209例，比较两组患者血脂指标、肝肾功能、颈动脉内膜中层厚度（IMT）和斑块面积。结果209例未服用他汀类的患者中，门诊医师未进行医嘱使用者68例（32．5％）；担心不良反应不愿服用者58例（27．8％）；检查血脂指标正常而自行停药者77例（36．8％）；3例（1．4％）发生皮肤过敏反应，停药后皮疹消失；3例（1．4％）发生肝酶明显升高，停药后逐渐正常。药物治疗组总胆固醇（TC）、三酰甘油（TG）和低密度脂蛋白胆固醇（LDL-C）分别为（4．93±0．45）mmol／L、（1．68±0．61）mmol／L和（2．49±0．57）mmol／L，明显低于对照组（5．87±0．38）mmol／L、（2．01±0．58）mmol／L、（3．76±0．44）mmol／L（t=18．60、4．46、20．94，P-0．000、0．007、0．000）；高密度脂蛋白胆固醇（HDL-C）（1．36±0．31）mmol／L明显高于对照组（1．03±0．25）mmol／L（t=9．75，P—0．001）。两组患者谷丙转氨酶、谷草转氨酶、碱性磷酸酶、血清总胆红素、直接胆红素、间接胆红素、尿素氮和肌酐差异均无统计学意义（均P〉0．05）。他汀类药物治疗组IMT为（1．62±0．23）mm，低于对照组（1．74±0．31）mm，而颈动脉粥样硬化斑块面积治疗组为（0．57±0．12）cm^2，小于对照组（0．65±0．18）cm^2（t-3．32、3．88，P-0．008、0．002）。结论急性脑梗死患者二级预防存在未服用他汀类药物情况，服用他汀类药物可以明显改善患者血脂指标和颈动脉状况，未见明显不良反应。
Objective To investigate the clinical application of statins for secondary prevention and its efficacy in patients with ischemic stroke. Methods A total of 300 patients with ischemic stroke were divided into statins group （n= 91） and control group （n= 209） according to whether statins was received or not. Serum lipid parameters, liver and kidney function, carotid artery intima- media thickness （IMT） and plaque area were compared between the two groups. Results In 209 patients not taking statins, 68 cases （32.5%） were not advised by clinic doctor; 55 cases （27.8%） were reluctant to take statins in fear of adverse reactions; 77 cases （36.8%） discontinued stains when serum lipids were normal; 3 cases （1.4%） developed skin allergic reaction and the skin rash that disappeared after stains discontinuance; 3 cases （1.4%） had elevated liver enzyme levels and the enzyme levels were declined to normal after stains discontinuance. The levels of total cholesterol （TC）, triglyceride （TG） and low density lipoprotein cholesterol （LDL-C） were significantly lower in statin group than in control group [（4.93±0.45） mmoI/Lvs. （5.87±0.38） retool/L, （1.68±0.61） mmol/L vs. （2.01±0.58） retool/L, （2.49±0.57） mmol/L vs. （3.76±0.44） retool/L, t=18.60, 4.46, 20.94, P=0. 000, 0. 007, 0. 000, respectively]. High density lipoprotein （HDL-C） level was significantly higher in stain group than in control group [（ 1.36 ±0.31） mmol/L vs. （ 1.03± 0.25） retool/L, t： 9.75, P=0.00l]. There were no significant differences in liver and kidney function parameters such as alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, serumtotal bilirubin, direct bilirubin, indirect bilirubin, glutamyl transferase, blood urea nitrogen and serum creatinine between the two groups （all P〉0.05）. The carotid IMT and carotid atherosclerotic plaque area were significantly lower in stain group than in control group [（1. 62±0. 23） mm vs. （1.74± 0.31） mm,（0.57±0.12） cm2 vs. （0.65±0.18） cm2, t=3.32, 3.88, P=0.008, 0.002, respectively]. Conclusions Most patients with ischemic stroke are still not taking statin for secondary prevention. Statins can improve the blood lipid levels and carotid arteriosclerosis status, and no obvious adverse reactions are observed.
出处
《中华老年医学杂志》
CAS
CSCD
北大核心
2013年第6期618-620,共3页
Chinese Journal of Geriatrics
关键词
卒中
二级预防
Stroke Secondary prevention
