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目的:通过长期对颈动脉粥样硬化斑块人群采取控制斑块、改善高危因素等综合干预,观察斑块面积、颈部动脉血管内至中层厚度(IMT)、斑块性质的改变及对缺血性卒中发生的影响。方法:将336例颈动脉粥样硬化斑块患者随机分为干预组和对照组。2组均接受低盐、低脂、低糖饮食控制。干预组在饮食控制基础上,口服阿托洛伐他汀20mg每日1次,连续12个月;同时给予控制血糖、降低同型半胱氨酸。结果:综合干预治疗12个月后,(1)颈动脉IMT、硬化斑块面积、性质与自身前和对照组对比有显著差异(均P<0.05)。(2)干预组总体卒中发生减少,与对照组有显著差异(P<0.05)。(3)对于颈动脉重度狭窄(狭窄率>90%),干预治疗后与对照组同等患者在缺血事件发生上,无显著差异(P>0.05);且降低血浆同型半胱氨酸对该类患者卒中的发生率没有显著关联(P>0.05)。结论:(1)对颈动脉硬化斑块人群长期给予调酯、降糖、控制血浆同型半胱氨酸等治疗,可稳定甚至缩小颈动脉粥样硬化斑块,达到斑块逆转,在二级预防中有助于预防卒中的发生。(2)而对于颈部动脉硬化斑块形成导致血管重度狭窄,狭窄率>90%的患者,综合干预不能降低卒中发生的风险。
OBJECTIVE: To observe the changes of plaque area, IMT, plaque characteristics and the effect of long-term carotid atherosclerotic plaque population on the control of plaque and improvement of risk factors. The impact of bloody stroke. Methods: 336 patients with carotid atherosclerosis were randomly divided into intervention group and control group. Both groups received low salt, low fat and low sugar diet control. Intervention group, based on diet control, oral atorvastatin 20mg once daily for 12 months; given to control blood sugar, reduce homocysteine. Results: After 12 months of comprehensive intervention, (1) There were significant differences in carotid IMT, sclerosis plaque area and nature between the two groups (P <0.05). (2) The total stroke incidence in the intervention group decreased significantly compared with the control group (P <0.05). (3) For patients with severe carotid stenosis (stenosis rate> 90%), there was no significant difference (P> 0.05) in the incidence of ischemic events between the intervention group and the control group, and the plasma homocysteine level There was no significant association between stroke rates in these patients (P> 0.05). Conclusion: (1) Long-term administration of transesterification, hypoglycemic and plasma homocysteine to carotid atherosclerotic plaques can stabilize and even narrow the carotid atherosclerotic plaque and achieve plaque reversal. Prevention helps prevent stroke. (2) For patients with atherosclerotic plaques in the neck that result in severe stenosis and stenosis> 90%, comprehensive intervention does not reduce the risk of stroke.