Nakase Taizen, Sasaki Masahiro, Suzuki Akifumi
Department of Stroke Science, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan.
Department of Stroke Science, Research Institute for Brain and Blood Vessels-Akita, Akita, Japan.
J Stroke Cerebrovasc Dis. 2014 Jul;23(6):1409-15. doi: 10.1016/j.jstrokecerebrovasdis.2013.11.023. Epub 2014 Feb 7.
Our objective was to investigate the effect of cilostazol in acute therapy for small vessel stroke patients. The neurologic deficits in some patients of small vessel brain infarction will progress even if a patient takes immediate medical treatments including aspirin or other antiplatelet drugs. In Japan, cilostazol, presenting not only the antiplatelet effect but also the arteriole dilation, is used for treatment of ischemic stroke. In this study, acute stroke patients with small vessel occlusion were treated with cilostazol instead of aspirin in the conventional medication after 2010. Therefore, patients between April 2007 and March 2009 were classified into the conventional group (group-con, n=220), and patients between April 2010 and March 2012 were classified into the cilostazol group (group-cilo, n=230). Enrolled patients were classified into lacunar infarction (LI) and branch atheromatous disease. Progressing stroke was defined as the increase of National Institutes of Health Stroke Scale score of 2 or more within 48 hours. The clinical outcome was assessed by the modified Rankin Scale (mRS) score at 1 month. As the result, the significant reduction in progressing stroke was dominant in the LI of brainstem (P=.01). The length of hospital stay was significantly shorter in the group-cilo compared with the group-con (18.6 and 21.2 days, P=.03). Moreover, mRS score at 1 month was significantly lower in the group-cilo than the group-con (1.9 and 2.3, P=.03). In conclusion, cilostazol reduced the risk of early neurologic deterioration of patients with small vessel brain infarction. It is eagerly desired to conduct a large randomized control trial.
我们的目的是研究西洛他唑在小血管性卒中患者急性治疗中的作用。即使小血管脑梗死患者立即接受包括阿司匹林或其他抗血小板药物在内的药物治疗，部分患者的神经功能缺损仍会进展。在日本，西洛他唑不仅具有抗血小板作用，还能扩张小动脉，用于治疗缺血性卒中。在本研究中，2010年后小血管闭塞的急性卒中患者在常规药物治疗中使用西洛他唑替代阿司匹林。因此，将2007年4月至2009年3月的患者分为常规治疗组（常规组，n = 220），将2010年4月至2012年3月的患者分为西洛他唑组（西洛他唑组，n = 230）。纳入的患者分为腔隙性梗死（LI）和分支动脉粥样硬化病。进展性卒中定义为在48小时内美国国立卫生研究院卒中量表评分增加2分或更多。临床结局通过1个月时的改良Rankin量表（mRS）评分进行评估。结果显示，进展性卒中的显著减少在脑干LI中占主导地位（P = 0.01）。与常规组相比，西洛他唑组的住院时间显著缩短（18.6天和21.2天，P = 0.03）。此外，西洛他唑组1个月时的mRS评分显著低于常规组（1.9和2.3，P = 0.03）。总之，西洛他唑降低了小血管脑梗死患者早期神经功能恶化的风险。迫切需要进行一项大型随机对照试验。
