预防性应用他汀类药物对老年急性脑梗死短期预后的影响

李健飞 沈闲茹 袁丹

[摘要]目的 探讨预防性应用他汀类药物对老年急性脑梗死短期预后的影响。方法 选取2016年6月～2017年6月我院收治的年龄>60岁的89例急性脑梗死患者作为研究对象，采用病例对照研究的方法分为观察组（45例）和对照组（44例）。观察组发病前应用他汀类药物（阿托伐他汀10 mg/d）半年以上，对照组则未应用。比较两组患者入院时的危险因素、空腹血糖、糖化血红蛋白、血脂水平、神经功能缺损情况，两组给予相同治疗方案治疗2周后评估神经功能缺损情况。结果 两组入院时的危险因素、空腹血糖及美国国立卫生研究院卒中量表（NIHSS）评分比较，差异无统计学意义（P>0.05）;观察组的三酰甘油、总胆固醇、低密度脂蛋白胆固醇水平及治疗2周后的NIHSS评分低于对照组，高密度脂蛋白胆固醇水平高于对照组，差异有统计学意义（P<0.05）。结论 预防性应用他汀类药物能改善老年急性脑梗死患者起病短期内的血脂水平及神经缺损功能，减轻致残程度。

[关键词]老年;脑梗死;他汀类药物;预后

[中图分类号] R743.3          [文獻标识码] A          [文章编号] 1674-4721（2019）8（a）-0045-03

[Abstract] Objective To investigate the influence of preventive use of statins on the short-term prognosis of acute cerebral infarction in the elderly patients. Methods A total of 89 patients with acute cerebral infarction aged over 60 years in our hospital from June 2016 to June 2017 were selected as the research objects. The patients were divided into the observation group （45 cases） and the control group （44 cases） by case-control study. The observation group was treated with statins （Atorvastatin 10 mg/d） for more than half a year before onset， while the control group was not. The risk factors， fasting blood glucose， glycosylated hemoglobin， blood lipid level and neurological defects of the two groups were compared at the time of admission， and the neurological defects were evaluated at 2 weeks after the same treatment regimen in the two groups. Results There was no significant difference in risk factors， fasting glucose and the national institutes of health stroke scale （NIHSS） scores between the two groups at admission （P>0.05）. The levels of triglyceride， total cholesterol， low density lipoprotein cholesterol and NIHSS score after 2 weeks of treatment in the observation group were lower than those in the control group， while the levels of high density lipoprotein cholesterol in the observation group were higher than those in the control group， the differences were statistically significant （P<0.05）. Conclusion Preventive use of statin drugs can improve the onset of lipid levels and nerve defects of the elderly patients with acute cerebral infarction in the short term， reduce the degree of disability.

[Key words] Old age; Cerebral infarction; Statins; Prognosis

随着我国生活及医疗水平的逐年提高，平均预期寿命快速增长，2015年人口预期寿命增长达到了76.34岁，已经接近发达国家水平[1]。人口老年化随之而来的是多种慢性疾病发病率增加，脑梗死为其中之一，约占全部脑血管病变的70%。目前认为其主要原因为脑动脉粥样硬化，而导致动脉粥样硬化发生是由长期多种因素共同作用的结果，高龄就是危险因素之一[2]。他汀类药物普遍应用于心脑血管病变二级预防，但有临床研究结果显示，他汀类药物预防治疗能够减轻急性脑梗死所致残障，减少死亡率[3]。本研究旨在探讨预防性应用他汀类药物对于老年患者出现脑梗死预后的影响，现将研究结果报道如下。