标题：阿托伐他汀钙与匹伐他汀钙对急性脑梗死合并颈动脉粥样硬化斑块患者颈动脉斑块和血脂的影响

      作者：文洪波，黄健康，姚义琴，张凤    南京市溧水区人民医院东南大学附属中大医院溧水分院神经内科，江苏 南京 211200

      卷次： 2021年32卷12期

      【摘要】 目的 探讨阿托伐他汀钙与匹伐他汀钙治疗急性脑梗死合并颈动脉粥样硬化斑块对患者颈动脉斑块、血脂的影响。方法 选取2018年10月至2019年10月在南京市溧水区人民医院住院治疗的急性脑梗死合并颈动脉粥样硬化斑块患者210例，采用抽签法随机分为阿托伐他汀钙组106例和匹伐他汀钙组104例，分别在脑梗死规范治疗基础上选用阿托伐他汀钙20 mg/d和匹伐他汀钙2 mg/d，治疗周期为6个月，比较两组患者治疗前及治疗后的斑块总数、颈动脉内膜中层厚度(IMT)、斑块面积和胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL-C)、高密度脂蛋白(HDL-C)水平，并比较治疗周期内缺血性卒中复发率。结果 治疗后，两组患者的 IMT、斑块面积均较治疗前减小，且阿托伐他汀钙组患者的颈动脉斑块面积为(30.01±14.13) mm2，明显小于匹伐他汀钙组的(33.89±13.57) mm2，差异均有统计学意义(P<0.05)，但治疗后阿托伐他汀钙组斑块总数为(1.56±0.48)个、IMT为(1.14±0.25) mm，分别与匹伐他汀钙组的(1.56±0.48)个、(1.20±0.21) mm比较差异均无统计学意义(P>0.05)；治疗后，阿托伐他汀钙组患者的TC和LDL-C水平分别为(2.96±0.38) mmol/L、(1.53±0.35) mmol/L，明显低于匹伐他汀钙组的(3.17±0.41) mmol/L、(1.74±0.43) mmol/L，差异均具有统计学意义(P<0.05)，但治疗后阿托伐他汀钙组患者的 TG、HDL-C水平分别(1.51±0.31) mmol/L、(0.96±0.27) mmol/L，与匹伐他汀钙组的(1.45±0.28) mmol/L、(1.02±0.26) mmol/L比较差异均无统计学意义(P>0.05)；阿托伐他汀钙组与匹伐他汀钙组患者的复发率分别为 10.4%、8.7%，差异无统计学意义(P>0.05)。结论 阿托伐他汀钙20 mg/d相比匹伐他汀钙2 mg/d在降低急性脑梗死合并颈动脉粥样斑块患者的血脂水平，减少颈动脉斑块面积，促进斑块稳定方面效果更显著，但两种药物在预防复发方面无明显差异。
      【关键词】 脑梗死；颈动脉斑块；阿托伐他汀钙；匹伐他汀钙；血脂
      【中图分类号】 R743.3 【文献标识码】 A 【文章编号】 1003—6350（2021）12—1541—04

Effect of atorvastatin calcium and pitavastatin on carotid plaque and blood lipids in patients with acute cerebralinfarction and carotid atherosclerotic plaque.
WEN Hong-bo, HUANG Jian-kang, YAO Yi-qin, ZHANG Feng.Department of Neurology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui Branch of Southeastern University,Nanjing 211200, Jiangshu, CHINA
【Abstract】 Objective To explore the effects of atorvastatin calcium and pitavastatin calcium on carotid plaqueand blood lipids in patients with acute cerebral infarction and carotid atherosclerotic plaque. Methods A total of 210 pa-tients with acute cerebral infarction combined with carotid atherosclerotic plaques who were hospitalized in the NanjingLishui People’s Hospital from October 2018 to October 2019 were randomly divided into an atorvastatin calcium group(106 cases) and a pitavastatin calcium group (104 cases) by lottery method. Based on the standard treatment of cerebralinfarction, the two groups were treated with atorvastatin calcium 20 mg/d and pitavastatin calcium 2 mg/d, respectively,and the treatment cycle was 6 months. The total number of plaques, carotid intima-media thickness (IMT), and plaque ar-ea were compared between the two groups before and after treatment, as well as the levels of cholesterol (TC), triglycer-ides (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C). And the recur-rence rates of ischemic stroke within the treatment cycle were compared between the two groups. Results After treat-ment, the IMT and plaque area of the two groups were reduced compared with those before treatment, and the carotidplaque area was smaller in the atorvastatin calcium group with (30.01±14.13) mm2 than in the pitavastatin calcium groupwith (33.89±13.57) mm2, and the difference was statistically significant (P<0.05). However, there were no significant dif-ferences in the total number of plaques with (1.56±0.48) vs (1.56±0.48) and IMT with (1.14±0.25) mm vs (1.20±0.21) mmbetween the atorvastatin calcium group and the pitavastatin calcium group after treatment (both P>0.05). After treat-ment, the levels of TC with (2.96±0.38) mmol/L vs (3.17±0.41) mmol/L and LDL-C with (1.53±0.35) mmol/L vs (1.74±0.43) mmol/L were significantly lower in the atorvastatin calcium group than in the pitavastatin calcium group (both P<0.05). But there were no significant differences in the levels of TG with (1.51±0.31) mmol/L vs (1.45±0.28) mmol/L and