阿托伐他汀联合氯吡格雷在颅外段颈动脉狭窄患者血管介入术中的应用  

The application of atorvastatin combined with clopidogrel in intravascular intervention of patients with extracranial carotid stenosis

作　　者：周伟坤[1] 黄根林[2] 邓欣欣 莫俊宁[2] 林培坚[1] 李福祥[1] ZHOU Wei-kun;HUANG Gen-lin;DENG Xin-xin;MO Jun-ning;LIN Pei-jian;LI Fu-xiang(Department of Cerebrovascular Area,the First People′s Hospital of Zhaoqing,Guangdong Privince, Zhaoqing526020,China;Department of Neurology,the First People′s Hospital of Zhaoqing,Guangdong Privince,Zhaoqing526020,China)

机构地区：[1]广东省肇庆市第一人民医院脑血管病区,广东肇庆526020 [2]广东省肇庆市第一人民医院神经内科,广东肇庆526020

出　　处：《河北医科大学学报》2019年第1期11-15,共5页Journal of Hebei Medical University

基　　金：肇庆市科技创新计划项目(2015040308)

摘　　要：目的探讨阿托伐他汀联合氯吡格雷在颅外段颈动脉狭窄(extracranial carotid stenostic,ECS)患者血管介入术中的应用。方法选取择期行血管介入术的82例ECS患者为研究对象,随机分为接受阿托伐他汀+氯吡格雷治疗的联合组(41例)和术后接受氯吡格雷治疗的对照组(41例),比较2组术后疗效和安全性。结果 2组手术支架植入成功率均为100%,2组术后3个月头颈CT血管造影均未发现再狭窄;2组术后3个月美国国立卫生研究院卒中量表评分、低密度脂蛋白胆固醇、总胆固醇、三酰甘油、颈动脉内中膜厚度、斑块数量和面积均显著下降(P<0.05);简易智力状况检查评分、高密度脂蛋白胆固醇均显著上升(P<0.05),且联合组各指标变化幅度均大于对照组(P<0.05);术后3个月2组血小板膜糖蛋白(CD62p、CD63p、GPⅡb/Ⅲa受体复合物)均显著下降(P<0.05),而联合组各血小板活化指标与对照组差异无统计学意义(P>0.05);2组并发症总发生率差异无统计学意义(P>0.05)。结论阿托伐他汀联合氯吡格雷可有效改善行血管介入术ECS患者的预后,改善血脂水平、神经功能缺损和认识功能,控制血小板活化。Objective To investigate the application of atorvastatin combined with clopidogrel inintravascular interventionof patients with extracranial carotid stenosis(ECS).Methods A total of82patients with ECS who underwent electiveintravascular intervention in the department of neurology in the hospital were selected as study subjects,and they were randomly divided into the combined group(treated with atorvastatin combined with clopidogrel,n=41)and the control group(treated with clopidogrelafter operation,n=41).The curative effect and safety were compared between the two groups.Results The successful rate of stent implantation in the two groups was100%.The head and neck CT angiography showed no restenosis in the two groups in3months after operation.The scores of National Institutes of Health Stroke Scale,low-density lipoprotein cholesterol,total cholesterol,triglyceride,carotid artery intima-media thickness,and the number and area of plaques were significantly decreased while Mini-Mental State Examination score and high-density lipoprotein cholesterol were significantly increased in the two groups in3months after operation(P<0.05).Changes of above-mentioned indexes in the combined group were greater than those in the control group(P<0.05).The platelet membrane glycoproteins(CD62p,CD63p,GPⅡb/Ⅲa receptor complex)were significantly decreased in the two groups in 3 months after operation(P<0.05),but there was no significant difference between the two groups in platelet activation indexes(P>0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusion Atorvastatin combined with clopidogrel can effectively improve the prognosis of ECS patients withintravascular intervention,improve blood lipid levels,relieve neurological impairment,improve cognitive function,and control platelet activation.

关 键 词：颈动脉狭窄 介入治疗 阿托伐他汀 氯吡格雷 

分 类 号：R543.4[医药卫生—心血管疾病]