无症状性颈动脉中重度狭窄的药物综合治疗疗效及预后

Comprehensive treatment regime on moderate to severe asymptomatic carotid artery stenosis: a two-year follow-up study

摘要:

目的 对无症状性颈动脉中重度狭窄患者的预后进行观察。方法 对陕西省人民医院2008年1月～2010年6月年住院患者进行颈动脉彩色多普勒超声筛查，将存在颈动脉粥样硬化斑块且狭窄率≥50%、且无同侧大脑半球缺血性卒中史的患者给予抗血小板、他汀、降压、降糖、戒烟等综合治疗。随访2年，观察患者死亡、卒中、心肌梗死等临床终点事件发生情况。结果 本研究共纳入颈动脉颅外段狭窄≥50%的患者177人，失访5人，共随访172人。38例（22.1%）发生缺血性卒中，其中24例发生于狭窄血管供血区（占卒中总数的63.2%），14例分别发生于对侧大脑半球及后循环，死亡8例，中位发病时间为18个月。坚持综合治疗组复合终点发生率（17.5%）明显低于未坚持综合治疗组（34.8%），差别具有统计学意义（P＝0.046）。结论 无症状性颈动脉中重度狭窄患者的药物综合治疗虽未减少卒中、死亡等独立终点事件发生率，但可明显减少复合终点事件发生率。如果任一种治疗措施执行得不规范，都可能导致复合终点事件发生率的升高。

Abstract:

Objective To observe the therapeutic effect and prognosis of our comprehensive treatment regime on moderate to severe asymptomatic carotid artery stenosis. Methods A prospective study was carried out in the inpatients receiving carotid Color Doppler ultrasonography in Shanxi Provincial People￠s Hospital from Jan. 2008 to Jun. 2010. The inclusion criteria included: age over 45 years, carotid artery atherosclerotic plaques and stenosis >50%, and without cerebral ischemic stroke. A comprehensive treatment regime was given to the subjects, including anti-platelet agents, statins, anti-hypertensive drugs, anti-diabetics, and smoking cessation. They all were followed up for 2 years to observe their clinical end point events, such as death, stroke, heart infarction and so on. Results There were finally 175 patients enrolled this study except 5 who were lost during follow-up. During the follow-up, 38 (22.1%) had ischemic stroke with a median onset time of 18 months. Twenty-four of them (accounting for 63.2% of total stroke) occurred in the areas with blood supplying by stenosed artery, and 14 had ischemic stroke in the opposite hemisphere and blood supplying areas of posterior circulation. Eight patients died. The composite end point event rate was significantly lower in patients with integrated treatment regime than those without (17.5% vs 34.8%, P＝0.046). Conclusions Our comprehensive treatment regime, though does not reduce the rate of independent end point event for patients with moderate to severe asymptomatic carotid artery stenosis, dose reduce the composite clinical end point event. The composite clinical end point event will be increased if any one of these measures is not strictly followed.