阿托伐他汀治疗与首次发生的动脉粥样硬化性短暂性脑缺血发作/中风中的颈动脉斑块形态：一项病例对照研究。

Atorvastatin treatment and carotid plaque morphology in first-ever atherosclerotic transient ischemic attack/stroke: a case-control study.

作者信息

Marchione Pasquale, Vento Claudio, Morreale Manuela, Izzo Chiara, Maugeri Andrea, Manuppella Federica, Romeo Tommaso, Giacomini Patrizia

机构信息

Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy; Operative Unit of Neurology, Department of Clinical Neurosciences, Neurological Center of Latium, Rome, Italy.

Neurosonology Unit, Department of Medical and Surgical Sciences and Biotechnologies - Section of Neurology, Faculty of Medicine and Pharmacy, Sapienza University of Rome, Rome, Italy.

出版信息

J Stroke Cerebrovasc Dis. 2015 Jan;24(1):138-43. doi: 10.1016/j.jstrokecerebrovasdis.2014.08.006. Epub 2014 Oct 22.

DOI:10.1016/j.jstrokecerebrovasdis.2014.08.006

PMID:25440329

Abstract

BACKGROUND

A relationship between echolucency of carotid plaques and the consequent risk of ipsilateral ischemic stroke has been observed. An aggressive lipid-lowering therapy may increase the echogenicity of carotid plaque in patients with elevated low-density lipoprotein cholesterol levels. The aim of this study is to prospectively evaluate the long-term effect of high-dose atorvastatin on carotid plaque morphology in patients with first-ever transient ischemic attack or stroke.

METHODS

All patients with symptomatic first ischemic atherosclerotic cerebrovascular event occurred within the previous 10 days were enrolled. Carotid Doppler ultrasound of the neck vessels with 7-11 MHz probe for the definition of the atherosclerotic carotid framework was performed. The analysis of the gray-scale median (GSM) of each plate was carried out with image processing software.

RESULTS

A total of 240 symptomatic plaques were included and divided into 3 groups: 80 in group A (atorvastatin 80 mg), 80 in group B (atorvastatin 40 mg), and 80 to group C (no atorvastatin). GSM score increases significantly more extensive in group A than in group B (+48.65 vs. +39.46, P < .02) and group C (+48.65 vs. 19.3, P = .0002). An inverse association between reduction of low-density lipoprotein and the increase in the GSM score (r = -.456, P = .007) has been observed. Moreover, the reduction of high-sensitive C-reactive protein correlates inversely with the increase of the GSM (r = -.398, P = .021).

CONCLUSIONS

Dose-dependent effect of atorvastatin on symptomatic carotid plaque morphology may suggest a specific role of this drug in the atherosclerotic stroke prevention.

摘要

背景

已观察到颈动脉斑块的回声性与同侧缺血性卒中的后续风险之间存在关联。积极的降脂治疗可能会增加低密度脂蛋白胆固醇水平升高患者颈动脉斑块的回声性。本研究的目的是前瞻性评估大剂量阿托伐他汀对首次短暂性脑缺血发作或卒中患者颈动脉斑块形态的长期影响。

方法

纳入所有在过去10天内发生有症状的首次缺血性动脉粥样硬化性脑血管事件的患者。使用7-11MHz探头对颈部血管进行颈动脉多普勒超声检查，以确定动脉粥样硬化性颈动脉结构。使用图像处理软件对每个斑块的灰阶中位数（GSM）进行分析。

结果

共纳入240个有症状的斑块，并分为3组：A组80个（阿托伐他汀80mg），B组80个（阿托伐他汀40mg），C组80个（未用阿托伐他汀）。A组GSM评分的增加明显比B组（+48.65对+39.46，P<.02）和C组（+48.65对19.3，P=.0002）更广泛。观察到低密度脂蛋白降低与GSM评分增加之间存在负相关（r=-.456，P=.007）。此外，高敏C反应蛋白的降低与GSM的增加呈负相关（r=-.398，P=.021）。