| Background:Statins have been confirmed with the stability of atherosclerotic plaque whichreduces the risk of the occurrence and recurrence of stroke. Further analysis hasshown that intensive lipid-lowering benefit more[1], but a study showed that statinstherapy in pharmacokinetic differences among different ethnic groups, Asians aremore sensitive to statins[2], and10mg of statins can significantly reduce the risk ofstroke[3], so the suitable statins dose for Chinese is controversial.Effect of statin on the recovery of neurological function in patients with stroke has becomethe focus of current research, but they does not see more, studies in different dosage of statinson apoplexy nerve function is more rare.Objective:1.To investigate the incidence of cerebrovascular events of different doses ofstatins on patients with anterior circulation ischemic stroke and middle cerebral arterystenosis and to analyse the influence of related factors of the recurrence of stroke.2To investigate the effects of different doses of statins in middle cerebral arterystenosis.3To investigate the effects of different doses of statins on the recovery ofneurological lfunction in patients with stroke.Methods：Using transcranial Doppler ultrasound (TCD) to screen acute ischemicstroke patients who had onset time within2weeks and visited neurology clinic of ourhospital from October2011to April2013. According to the diagnostic criteria ofstenosis by TCD,167patients (man93,women74, average age66.1±11.65years) weredetected with ischemic stroke in the anterior circulation combined middle cerebralartery stenosis, and whose ipsilateral carotid stenosis was less than50%by carotidultrasonography check. All patients were randomly divided into90cases of high-dosegroup (atorvastatin40mg/d) and low-dose group with77caese (atorvastatin10mg/d).Meliorate RANKIN Scale (MRS) and Meliorate Barthel Index rating scale (MBI) were used as stroke neurological evaluation. Stroke risk factors, stroke neurological scores,blood lipids, fasting plasma glucose, glycated hemoglobin, liver and kidney function,creatine kinase, blood routine examination and the other generally situation wererecorded when patients admitted to hospital. All patients treated underlying diseasespositively, such as the control of blood pressure, regulate blood sugar, anti-plateletaggregation, except lipid-lowering therapy. Conduct monthly telephone follow-up afterdischarge, mainly observed the recurrence cerebrovascular events and drugcompliances. All patients were carried stroke neurological assessment respectively in2weeks,3months and1year after hospital treatment, the changing of MCAS stenosisand blood lipid were reviewed after one year treatment. Static-analysis was taken bySPSS version13.0for windows software package, P value <0.05was consideredstatistically significant.1. After1year,16patients were lost and the follow-up was completed with151patients,including80cases in high-dose group (mean age64.39±11.55years) and71cases inlow-dose group (mean age66.27±13.56years). There was no significant ststisticdifference between the two groups (P>0.05) in age, gender, diabetes, hypertension,smoking history, alcohol consumption, hyperlipidemia, coronary heart disease, lipidlevels, fasting blood glucose, glycated hemoglobin, creatine kinase, liver and kidneyfunction..2. Outcome of168MCAS. There were168MCAS in151patients. Among89MCASin high-dose group,43(43/89,48.3%) of the stenosis were mild,31(31/89,34.8%)were moderate,15(15/89,16.9%) were severe. Among79MCAS in low-dose group,45(45/79,57.0%) of the stenosis were mild,20(20/79,25.3%) were moderate,14(14/79,17.7%) were severe, MCAS stenosis had no significant ststistic differencebetween the two groups (P>0.05). After one year treatment, the results of follow-upTCD were shown below: among89MCAS in high-dose group,37(37/89,41.5%) wereregressed MCAS,45(45/89,50.6%) were stable,7(7/89,7.9%) were progressedMCAS; among79MCAS in low-dose group,20(20/81,24.7%) were regressed MCAS,45(45/81,55.5%) were stable MCAS,16(16/81,19.8%) were progressed MCAS.16were progressed MCAS,2were new-onset MCAS, others were progressed based onstenosis. There was ststistically significant difference on stenosis vessels between thetwo groups (P <0.05). The number of regressed blood vessels in high-dose group wassignificantly more than the low-dose group, and progressed number was significantlyless than the low-dose group (P <0.05). 3. Lipid changes in two groups of patients. Compared baseline and lipid value afterone year treatment, the levels of CHOL, TG, LDL-C in the two groups weresignificantly decreased (P <0.05), and the HDL-C was increased (P <0.05). The level ofCHOL and LDL-C in high-dose group decreased more significantly and HDL-Cincreased more significantly. There was ststistically significant difference in CHOL,LDL-C and HDL-C,(P <0.05), but there was no significant difference on TG betweenthe two groups (P>0.05).4. Recurrent of stroke. During the one year follow-up, there were16cases of ischemicstroke events (16/151,10.6%), in which4cases recurrenced in high dose group (4/80,5%),3cases from MCAS progressed,1case of stenosis stable.12patients recurrencedin low-dose group (12/71,16.9%),10cases of which were MCAS progressed, twocases of stenosis stable. Recurrent of stroke was statistically significant between thetwo groups (P <0.05).5. Recovery of neurological function: MBI and MRS scores of two groups of patientswere not significant difference on admission (P>0.05). After hospitalized for14days,there was not statistically significant difference (P>0.05) among MRS score, MBIscore and baseline. After treatment of3months and1year respectively, the MRS scorein the high-dose group was significantly lower than the low-dose group, and the MBIscore in the high-dose group was significantly higher than the low-dose group,All thestatistical results were statistically significant (P <0.05);6. Univariate comparison between stroke recurrence group and non-recurrencegroup: The151patients were divided into the recurrence group (16cases) and thenon-recurrence group (135cases) according to recurrent of stroke. Univariate analysisshowed that diabetes, LDL-L, HbA1C, MCA severe stenosis and high-dose statintherapy were statistically significant (P<0.05), age, gender, hypertension, smoking,drinking history, hyperlipidemia, coronary heart disease, lipid levels, fasting glucose,creatine kinase, liver and kidney function showed no significant difference (P>0.05).7. Univariate comparison of recurrent stroke cases in two groups: Univariatecomparison between4cases of recurrent stroke in high-dose group and12cases ofrecurrent stroke group in low dose group showed, that there was no statisticallysignificant difference among history of diabetes, LDL-L, HbA1C and MCA severestenosis (P>0.05).8Multi-factor analysis of stroke recurrence: Multivariate logistic regression analysis was made, which the the recurrence was considered as the dependent variable,age, gender, diabetes, hypertension, smoking, drinking history, hyperlipidemia, CHOL,TG, HDL-C, LDL-C, FBS, HbA1c, systolic blood pressure, diastolic blood pressure,MCA severe stenosis, high dose statin therapy were chosen as independent variables.The results showed that diabetes, LDL-L, MCA severe stenosis were independent riskfactors for recurrence ischemic stroke with the OR value of5.316,4.286and10.176respectively. High-dose statin therapy was a protective factor for recurrence ischemicstroke, OR value was0.137.Conclusion：1. High-dose statin therapy can more effectively reduce the risk of recurrence stoke onpatients with anterior circulation ischemic stroke and middle cerebral artery stenosisthan lose-dose statin therapy.2. High-dose statin therapy can more significantly stabilize or reverse middle cerebralartery stenosis than lose-dose statin therapy.3. High-dose statin therapy can more effectively promote the recovery of neurologicalfunction in stoke patients than lose-dose statin therapy.4. Diabetes, LDL-L, MCA severe stenosis are independent risk factors for strokerecurrent, High-dose statin therapy is protective factor for stroke recurrence. |
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