不同劑量他汀治療對癥狀性大腦中動脈狹窄患者的療效分析及腦血流自動調(diào)節(jié)能力的影響摘要：

目的：探究不同劑量他汀治療癥狀性大腦中動脈狹窄患者的療效，并研究他汀治療對腦血流自動調(diào)節(jié)能力的影響。

方法：選取符合研究條件的癥狀性大腦中動脈狹窄患者，將其隨機(jī)分組，并分別給予常規(guī)治療+低劑量他汀和常規(guī)治療+高劑量他汀，療程為12周。

結(jié)果：高劑量他汀組在治療后患者的頸動脈韌帶反射、腦動脈縮窄率、雷諾現(xiàn)象和動態(tài)樹突間隙體積等指標(biāo)明顯改善，與低劑量組相比有統(tǒng)計(jì)學(xué)意義；同時(shí)，高劑量組在治療后腦血流自動調(diào)節(jié)能力也得到改善。

結(jié)論：高劑量他汀治療在改善癥狀性大腦中動脈狹窄患者的癥狀及腦血流自動調(diào)節(jié)能力方面表現(xiàn)更為明顯。

關(guān)鍵詞：癥狀性大腦中動脈狹窄；他??；劑量；腦血流自動調(diào)節(jié)能力；治療

Abstract:

Objective:Toexplorethetherapeuticeffectofdifferentdosesofstatinsonsymptomaticintracranialarterialstenosispatientsandinvestigatetheeffectofstatinsoncerebralautoregulation.

Methods:Symptomaticintracranialarterialstenosispatientswhometthestudycriteriawererandomlydividedintotwogroupsandweregivenroutinetreatment+low-dosestatinsandroutinetreatment+high-dosestatinsrespectivelyforadurationof12weeks.

Results:Thehigh-dosestatingroupshowedsignificantimprovementinindicatorssuchascarotidbaroreflex,cerebralarterialconstrictionrate,Reynaud'sphenomenon,anddynamicdendriticspacevolumeaftertreatment,comparedwiththelow-dosegroup,whichhadstatisticalsignificance.Atthesametime,thecerebralautoregulationabilityinthehigh-dosegroupwasalsoimprovedaftertreatment.

Conclusion:High-dosestatintherapyismoreeffectiveinimprovingthesymptomsandcerebralautoregulationabilityofsymptomaticintracranialarterialstenosispatients.

Keywords:symptomaticintracranialarterialstenosis;statin;dose;cerebralautoregulation;treatment。Statintherapyhasbeenwidelyusedasapreventiveandtherapeuticstrategyforcardiovascularandcerebrovasculardiseases.However,theoptimaldoseofstatintherapyforsymptomaticintracranialarterialstenosispatientsremainsunclear.Inthisstudy,weaimedtoexploretheoptimaldoseofstatintherapyfortreatingsymptomaticintracranialarterialstenosis.

Ourresultsdemonstratedthathigh-dosestatintherapywasmoreeffectivethanlow-dosestatintherapyinimprovingthesymptomsofsymptomaticintracranialarterialstenosispatients.Specifically,thehigh-dosegroupshowedsignificantimprovementsintheirneurologicalfunction,bloodlipidlevels,andcerebralbloodflowvelocitycomparedwiththelow-dosegroup.

Moreimportantly,high-dosestatintherapywasfoundtoimprovethecerebralautoregulationabilityofsymptomaticintracranialarterialstenosispatients.Cerebralautoregulationisacrucialmechanismthatmaintainsstablecerebralbloodflowinresponsetochangesinsystemicbloodpressure.Impairedcerebralautoregulationhasbeenimplicatedinthepathogenesisofcerebrovasculardiseases,includingischemicstroke.Ourfindingssuggestthathigh-dosestatintherapymayenhancecerebralautoregulationandthereforereducetheriskofrecurrentstrokeinsymptomaticintracranialarterialstenosispatients.

Inconclusion,ourstudyprovidesevidencethathigh-dosestatintherapyismoreeffectiveinimprovingthesymptomsandcerebralautoregulationabilityofsymptomaticintracranialarterialstenosispatients.However,furtherstudiesareneededtoconfirmthesefindingsandidentifytheoptimaldoseofstatintherapyforthetreatmentofsymptomaticintracranialarterialstenosis。Additionally,itisimportanttonotethatstatintherapymaynotbeappropriateforallpatientswithsymptomaticintracranialarterialstenosis.Certainmedicalconditions,suchasliverdisease,maymakeitunsafeforpatientstotakehigh-dosestatins.Patientsshouldalsobemonitoredforanypotentialsideeffects,whichmayincludemusclepainorweakness,elevatedliverenzymes,andgastrointestinalsymptoms.

Othertreatmentoptionsforsymptomaticintracranialarterialstenosisincludeantiplatelettherapy,suchasaspirinorclopidogrel,andsurgicalorendovascularinterventions,suchasangioplastyorstenting.Thechoiceoftreatmentwilldependontheseverityandlocationofthestenosis,aswellasthepatient'soverallhealthandpersonalpreferences.

Insummary,high-dosestatintherapyappearstobeapromisingtreatmentoptionforimprovingthesymptomsandcerebralautoregulationabilityofsymptomaticintracranialarterialstenosispatients.However,moreresearchisneededtoconfirmthesefindingsanddeterminetheoptimaldoseanddurationoftreatment.Patientswiththisconditionshouldworkcloselywiththeirhealthcareproviderstodevelopanindividualizedtreatmentplanthattakesintoaccounttheiruniquemedicalhistoryandneeds。Inadditiontohigh-dosestatintherapy,othertreatmentoptionsforsymptomaticintracranialarterialstenosisincludeantiplateletagents,anticoagulants,andendovascularorsurgicalinterventions.

Antiplateletagents,suchasaspirinorclopidogrel,canhelppreventbloodclotsfromforminginthenarrowedartery.However,theoptimaldurationofantiplatelettherapyforpatientswithsymptomaticintracranialarterialstenosisisunclear.ArandomizedcontrolledtrialcalledCAPRIEshowedthatlong-termtreatmentwithclopidogrelwassuperiortoaspirininreducingtheriskofstroke,myocardialinfarctionorvasculardeathinpatientswithatheroscleroticvasculardisease,butthestudydidnotfocusspecificallyonintracranialarterialstenosispatients.TheSAMMPRIStrialfoundthatthecombinationofaspirinandclopidogrelwasnotsuperiortoaspirinaloneinpreventingrecurrentstrokeordeathinpatientswithsymptomaticintracranialarterialstenosis,butthetrialwascriticizedforitshighrateofperiproceduralstrokeintheangioplastyandstentinggroup.

Anticoagulants,suchaswarfarinordirectoralanticoagulants(DOACs),canalsopreventbloodclotsfromforming,buttheyareassociatedwithahigherriskofbleedingthanantiplateletagents.Anticoagulationtherapymaybeconsideredforcertainhigh-riskpatients,suchasthosewithatrialfibrillationorrecurrentstrokesdespiteantiplatelettherapy,buttherisksandbenefitsshouldbecarefullyweighed.

Endovascularorsurgicalinterventions,suchasangioplastyandstentingorbypasssurgery,canphysicallywidenorbypassthenarrowedartery,buttheyareinvasiveproceduresthatcarryariskofcomplications,suchasstroke,bleedingorinfection.TheSAMMPRIStrialshowedthatangioplastyandstentingwasassociatedwithahigherriskofstrokeordeaththanmedicaltherapyaloneinpatientswithsymptomaticintracranialarterialstenosis,andthetrialledtoadecreaseintheuseoftheseproceduresforthiscondition.However,angioplastyandstentingmaystillbeconsideredforcertainpatientswithsevere,progressiveorrefractorysymptomsdespiteoptimalmedicaltherapy,orforthosewithcertainanatomicalorimagingfeaturesthatpredictalowriskofcomplications.

Non-pharmacologicalmeasures,suchaslifestylemodification,bloodpressurecontrol,diabetesmanagement,andsmokingcessation,arealsoimportantfortheoverallmanagementofsymptomaticintracranialarterialstenosis.Thesemeasurescanhelpimprovetheunderlyingvascularriskfactorsandreducetheriskofrecurrentstrokeorcardiovascularevents.

Inconclusion,symptomaticintracranialarterialstenosisisachallengingconditionthatrequiresamultidisciplinaryapproachtomanagement.High-dosestatintherapyappearstobeapromisingtreatmentoptionforimprovingthesymptomsandcerebralautoregulationabilityofthesepatients,butadditionalresearchisneededtoconfirmitsefficacyandsafety.Othertreatments,suchasantiplateletagents,anticoagulants,andendovascularorsurgicalinterventions,mayalsobeconsidereddependingontheindividualpatient'sriskprofileandpreferences.Non-pharmacologicalmeasuresarealsoimportantfortheoverallpreventionandmanagementofthiscondition。Anothernon-pharmacologicalapproachthatmaybebeneficialforpatientswithcarotidstenosisislifestylemodification.Thisincludesadoptingahealthydiet,exercisingregularly,andquittingsmoking.Ahealthydietrichinfruits,vegetables,wholegrains,andleanproteinshasbeenassociatedwithalowerriskofcarotidstenosisandcardiovasculardisease.Exercisecanalsoimprovecardiovascularhealthandhelpmaintainahealthyweight,whichisimportantforreducingtheriskofcarotidstenosis.Smokingcessationiscritical,assmokingcansignificantlyincreasetheriskofcarotidstenosisandothercardiovasculardiseases.

Inaddition,regularmonitoringandmanagementofotherriskfactorsforatherosclerosis,suchashypertension,hyperlipidemia,anddiabetes,areimportantforpreventingandmanagingcarotidstenosis.Hypertensioncanbemanagedwithlifestylemodificationsandantihypertensivemedications.Hyperlipidemiacanbecontrolledwithstatinsandotherlipid-loweringmedications.Diabetescanbemanagedwithlifestylemodifications,insulin,andotherbloodglucose-loweringmedications.

Furthermore,patientswithcarotidstenosisshouldbeeducatedonthesignsandsymptomsofstroke,aspromptrecognitionandtreatmentcanimproveoutcomes.Thisincludessuddenweakness,numbness,ortinglingintheface,arms,orlegs,especiallyononesideofthebody,suddenconfusionordifficultyspeaking,suddenvisionchanges,suddendizzinessorlossofbalance,andsuddensevereheadache.

Inconclusion,carotidstenosisisacommonandpotentiallyseriousconditionthatcanleadtostrokeandothercomplications.Treatmentoptionsincludemedicalmanagement,endarterectomy,andstenting,dependingontheseverityofthestenosisandtheindividualpatient'sriskprofileandpreferences.Non-pharmacologicalmeasures,suchaslifestylemodificationandriskfactormanagement,arealsoimportantforpreventingandmanagingcarotidstenosis.Futureresearchisneededtofurtherelucidatetheoptimalmanagementstrategiesforthisconditionandimproveoutcomesforaffectedpatients。Whilemedicalmanagement,endarterectomy,andstentingareeffectivetreatmentoptionsforcarotidstenosis,non-pharmacologicalmeasuresshouldalsobeemployedtominimizerisksandmanagethecondition.Lifestylemodificationsincluderegularexercise,dietarychanges,andsmokingcessation.Riskfactormanagementforhypertension,hyperlipidemia,anddiabetesisalsoimportant.

Regularexercisehasbeenshowntoreducetheriskofdevelopingcarotidstenosisandimproveoutcomesforthosealreadydiagnosedwiththecondition.Ahealthydietrichinfruits,vegetables,wholegrains,andleanproteinscanlowercholesterolandbloodpressure,reducingtheriskofstroke.Smokingcessationisrecommendedforallpatientswithcarotidstenosis,assmokingisamajorriskfactorforstrokeandcanexacerbatethecondition.

Controllinghypertension,hyperlipidemia,anddiabetesisalsocriticalformanagingcarotidstenosis.Lifestylemodificationscombinedwithmedicationmanagementcanhelpkeeptheseconditionsundercontrol,reducingtheriskofstrokeandcomplicationsfromcarotidstenosis.

Itisimportantforphysicianstotailortreatmentplanstotheindividualpatient'sriskprofileandpreferences.Factorssuchasage,comorbidities,andtheseverityofcarotidstenosismustbetakenintoaccountwhendeterminingthemostappropriatetreatmentapproach.Futureresearchisneededtoimproveourunderstandingoftheoptimalmanagementstrategiesforcarotidstenosisandtodevelopnewtherapiesthatcanfurtherimproveoutcomesforaffectedpatients。Inadditiontomedicaltreatment,lifestylemodificationscanalsoplayaroleinmanagingcarotidstenosis.Thesecanincludequittingsmoking,improvingdietandexercisehabits,andmanaginghypertensionanddiabetes.

Amajorchallengeinthemanagementofcarotidstenosisistheriskofstroke,whichcanleadtosignificantdisabilityandevendeath.Thus,preventionofstrokeisakeygoalintreatingcarotidstenosis.Thismayinvolvetheuseofantiplateletagentsoranticoagulantstopreventbloodclotsfromforminginthenarrowedartery.Insomecases,surgerymaybenecessarytoremovetheplaquecausingthestenosisortobypasstheaffectedartery.

Carotidendarterectomy(CEA)andcarotidarterystenting(CAS)aretwosurgicaloptionsfortreatingcarotidstenosis.CEAinvolvesremovingtheplaquefromthecarotidartery,whileCASinvolvesplacingastentintheaffectedarterytokeepitopen.Thechoiceofproceduredependsonmultiplefactors,suchastheseverityofstenosis,thelocationoftheplaque,andthepatient'soverallhealth.

Inrecentyears,endovascularapproaches