| ObjectiveTransient ischemic attack(TIA)is transient,recurrent cerebral ischemic and neurologic afunction. It's one of the most multiple cerebrovascular disease in middle and aged people,which possess high morbility,reversibility and risk of progress to cerebral arterial thrombosis.Although the patient of TIA have a good turnover in the near future, it'still quite high in long-term risk of death and handicap.So it's very important to prevent and treat it.As is knowed from etiopathogenisis and pathogenesy, aggregation of platelet, abnormity of blood fat and form of cervical atherosclerotic plaque are factors that is closely related with TIA.This study starts with clinic,applies aspirin and probucol and aim directly at several factors above.At last,it confirms mechanism of action and therapeutic rationale of aspirin and probucol in treating TIA.It also supplies rationale for its general application in clinic.Methods125 TIA patients who visited neurology department(out-patient clinic or inpatient department ) of our hospital from Jan, 2006 to Jan,2007 were divided into two groups randomly,treatment group(65 cases) and control group(60 cases). All the patients accepted the treatment of ginseng saponin intravenous drip for14 days.Besides,treatment group took asipirin and probucol for oral use.Blood fat in plasma was measured by enzymic method and electrophoresis method before and after 6-months treatment. Blood viscosity was investigated by LBY-N6B automatic multi-function blood rheometer before and after 6-months treatment. In addition, we detected condition of intracranial arterial blood flow with TCD, carotid atherosclerotic plaque carotid with carotid Color Doppler ultrasonography and assessed the clinical effect after half a year and one year.Results(1) The numbers of those who had blood fat (one item or more)abnormality in treatment group compared with control group.The distinction had no statistical significance (P>0.05).The level of TC,HDL-C and LDL-C in treatment group after half a year degraded by 28.47%,17.39% and 17.84% respectively compared with control group. The distinction had statistical significance (P<0.05).But the distinction of TG that degraded by 2.29% in treatment group had no statistical significance (P>0.05) comparing with control group after treatment.The level of TC,HDL-C and LDL-C in treatment group descended (P<0.05) comparing control group after treatment. But the TG was invariable.(2) After half a year treatment, high blood viscosity,middle blood viscosity, low blood viscosity, plasma viscosity degraded, and erythrocyte deformation index upgraded (P<0.05).Other index,just like blood sedimentation, hematocrit and so on, did not differ when compared between two groups (p>0.05).(3) TCD displayed:The number of TIA patients who exsisted AS, arterial stenosis, microemboli defluxion(one item or more) was 108,with a rate of abnormality 86.40%. carotid Color Doppler ultrasonography displayed: 90 cases (72.00%) exsisted AS. Stabilized plaques were detected 92 places.47 places were in treatment group and the others in control group. Instabilized plaques had 31 places of which included 16 in treatment group and 15 in another.There was no difference (p>0.05) between the two groups in rate of instabilized plaques. Among the total,42 cases were confirmed by MRA,20 by CTA and 2 by DSA. The coincidence between ultrasound and MRA,CTA,DSA was 95%.(4)Before treatment,stabilized plaques were detected 58 places in responsible sides and 34 places in irresponsible sides; Instabilized plaques were detected 26 places in responsible sides and 5 places in irresponsible sides. The distinction had statistical significance (P<0.05).(5)In treatment group, stabilized plaques were detected 47 places while instabilized ones were 16 places before treatment.After one year's intervention of aspirin and probucol.The numbers of stabilized plaques increased by 56.That of instabilized plaques decreased by 7. The distinction also had statistical significance (P<0.05).(6)We compared the peaked blood flow rate of MCA in patients who exsisted MCA stegnosis in treatment and control group before and after one year's intervention.It displayed,difference exsisted between before and after treatment in treatment group(P<0.05),and also exsisted between the two groups after treatment(P<0.05).(7)In half a year's follow-up, the total effective rate (including recovery and improvement) in treatment group was 78.46%.It's higher than 61.67% in control group. Infarctus rate 9.23% was lower than that of control group 21.67%.When we followed up after one year,we found the total effective rate was 69.23%. It's also higher than 41.67% in control group. Infarctus rate 9.23% was still lower than that of control group 26.67%. There had statistical significance between two groups's prognosis (P<0.05). Another, in one year's follow-up, internal carotid artery systerm had a significantly higher total effective rate 73.81% in treatment group than that of in controls 45.00%. Infarctus rate 7.14% was lower than that of control group 22.50%; Vertebra- basilar artery systerm had a significantly higher total effective rate 60.87% in treatment group than that of in controls 35.00%. Infarctus rate 13.04% was lower than that of controls 35.00%.Conclusions1,Probucol can degrade the level of TC,HDL-L and LDL-C in TIA patients.But it has no effect on TG.2,The majority of TIA patients who were presented structural disease in TCD and (or) carotid Color Doppler ultrasonography have hemorheology abnormity.3,Probucol can degrade high blood viscosity,middle blood viscosity, low blood viscosity, plasma viscosity, and upgrade erythrocyte deformation index.Thus it can improve microcirculation,increase brain tissue's blood-supply and ventilation by erythrocyte in TIA patients.4,Probucol can reduce the peaked blood flow rate of MCA in patients who exsisted MCA stegnosis.5,Aspirin combined with can cut down infarctus rate of TIA patients in half a year and one year's follow-up.They can also decrease seizure frequency of TIA, as well, they have a convenient administration route and little adverse reaction in long-term administration.6,Instabilized plaques can induce TIA more easily than stabilized plaques. Probucol can decrease the number of instabilized plaques,increase that of stabilized plaques.It explains probucol has the effect of stabling plaques.7,With regard to TIA patients,Neither TCD nor carotid Color Doppler ultrasonography can supply haemodynamic information from vascular in or out cranium.we should connect the two,otherwise it's difficult to reflect etiology of TIA exactly and roundly. |
PDF Full Text Request