症状性颈内动脉完全闭塞患者的临床干预和随访研究  

Clinical interference and follow-up studies in patients with symptomatic carotid artery total occlusion

作　　者：杨华 夏章勇[2] 张敏[3] 任增光 殷勤[3] 徐格林[3] 曲怀谦[2] 王丽[4] 

机构地区：[1]聊城市第三人民医院神经内科,252000 [2]山东省心脑血管病微创治疗工程技术研究中心聊城市人民医院神经内科,聊城252000 [3]南京大学神经病学研究所南京军区南京总医院神经内科,南京210002 [4]潍坊市寒亭区人民医院检验科,261100

出　　处：《中华神经医学杂志》2011年第11期1092-1096,共5页Chinese Journal of Neuromedicine

基　　金：“十一五”国家科技支撑计划分支研究（2006BA101A11）

摘　　要：目的评价症状性颈内动脉完全闭塞患者介入治疗和药物治疗的效果，观察临床干预后血管事件的随访结果。方法将自2004年2月至2009年1月在聊城市人民医院和南京军区南京总医院神经内科住院的62例症状性颈内动脉完全闭塞患者意向性分为介入组和药物组．介入组21例给予颈内动脉闭塞血管再通术，药物组41例给予阿司匹林、氯吡格雷及他汀类药物治疗。随访主要终点事件为发病2年时患者功能预后，以改良的Rankins评分（mRS评分）为依据，秩和检验比较组间平均秩次的差异；次要终点事件为血管事件的再发，Kaplan—Meier法及多因素Cox回归分析其中位数时间及独立危险因素。结果在随访3月、6月、1年及2年时，介入组患者mRS评分平均秩次均明显低于药物组，差异有统计学意义（P〈0．05）。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）个月和（19．43±1．51）个月，比较差异无统计学意义（P〉0．05）。多因素Cox回归分析表明患者再发血管事件的独立危险因素主要包括吸烟（RR=3．189，95％CI：1．020-9．968，P=-0．046）、糖尿病假R=2．717，95％CI：1．113-6．631，P=0．028）及基线时美国国立卫生研究院卒中量表（NIHSS）评分（RR=2．984，95％CI：1．049～8．485，P=0．040），而治疗方案（介入治疗和药物治疗）不是血管事件再发的独立影响因素（RR=I．191，95％CI：0．430～3．296，P=0．737）。结论对于症状性颈内动脉完全闭塞患者，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评分是其血管事件再发的独立危险因素。Objective To evaluate the effects of artery-interventional therapy and drug treatment on patients with symptomatic carotid artery total cerebrovascular events after clinical interference. occlusion, and observe the follow-up results of Methods According to patient＇s intention, 62 patients with symptomatic carotid artery total occlusion, admitted to our hospitals from February 2004 to January 2009, were divided into artery-interventional therapy group （n=21） and drug treatment group （n=41）. In the artery-interventional therapy group, patients were given revascularization of internal carotid by endovascular intervention. In the drug treatment group, patients were given aspirin, clopidogrel and statins. The major end-point outcome of follow-up survey was the 2-year functional prognosis evaluated by modified Rankin Scale （mRS）, and Rank sum test was employed to compare the differences of mean rank of the 2 groups; the minor end-point outcome was the cardiovascular events, and Kaplan-Meier method and multivariate Cox regression were employed to analyze the median time and independent risk factors. Results During the 3, 6 and 9 months, 1 and 2 years of follow-up, mRS average ranks in the artery-interventional therapy group were statistically lower than those in the drug treatment group （P〈 0.05）. The median times of recurrence of cardio-cerebrovascular events in the artery-interventional therapy group and drug treatment group were （17.42±1.20） months （95%CI： 15.07-19.76） and （19.43± 1.51） months （95%CI： 16.48-22.38）, respectively, and Kaplan-Meieranalysisshowednosignificant difference （P〉0.05）. Survival Cox regression analysis showed that independent factors of cardio-cerebrovascular events 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 scores （RR=2.984, 95%CI： 1.049-8.485, P= 0.040）, but treatment methods （artery-interventional therapy and drug treatment） were not indepe

关 键 词：颈内动脉 血管闭塞 支架 随访研究 

分 类 号：R743.3[医药卫生—神经病学与精神病学]