| Objective The definite efficacy of statin in the prevention and treatment of ischemic stroke has been widely recognized.Its advantage is strengthening lipid-lowering and has been applied to clinical use,Rosuvastatin and atorvastatin are the most common statin medicines,but the selection of the two kinds is still controversial..This study compared the efficacy and safety of the two kinds of medicines in enhancing lipid-lowering in acute cerebral infarction.Methods 114 patients with acute primary cerebral infarction were enrolled from January 2016 to December 2016 in the first affiliated hospital of Dalian medical university,including 79 males and 35 females.They are between 50-80 years old.All patients were randomly divided into two groups.There are 57 patients in rosuvastatin group(group A),including 41 males and 16 females.The mean age is(64..89 ± 9.10),There are 57 patients in atorvastatin group.All patients were diagnosed as acute cerebral infarction by CT or MRI.on the first onset;or within 48 hours from the onset or didn`t take statins in the past one month.Exclusion criteria are: cardiogenic embolism and other cerebral embolism caused by trauma or cancer;patients with severe heart diseases,liver failure,renal function insufficiency and gastrointestinal diseases;pregnancy and lactating women;a history of allergy reaction to statins;cerebral bleeding secondary to infarctions;combined with severe nutritional or metabolic disorders.All patients were given aspirin 100 mg + clopidogrel 75 mg double anti-platelet aggregation treatment,improving circulation,nurturing the nerves and other treatment,as well as controlling blood pressure、blood glucose,correcting ion disorder in a reasonable way.Besides these treatments,patients in group A received oral rosuvastatin 20 mg once every night.Patients in group B received oral atorvastatin 60 mg once ever night.The course of the treatment is 5 weeks.At the time of discharge,the patients and their family members were educated on the necessity of taking medicine,the follow-up time,and reexamining items.Withdrawal criteria are: occurrence of gastrointestinal discomfort;AST or ALT 2 times higher than the normal values;severe renal function impairment;muscle pain or creatine kinase 3 times higher than the normal values;patients who refused to take drugs and so on.All patients` fasting blood were withdrawn before the treatment and one week after the treatment(about the time of discharge)、5 weeks after the treatment to assay blood lipid levels(TG,TC,LDL,HDL),liver and kidney function(creatinine,ALT,AST),creatine kinase.After 5 weeks of treatment,the patients` conditions of relapse,medication and adverse reactions were investigated through telephone and out-patient follow-up.We used SPSS 19.0 statistical analysis software to analyze the data.The measurement data were presented as mean ± standard deviation.We used t test to compare data between groups;the count data were presented as rate and we used X~2 test to compare data between groups.The difference of P<0.05 was statistically significant.Results(1)There was no significant difference between the baseline scores(age,sex,smoking rate and hypertension,diabetes mellitus)in all selected patients(P> 0.05).All were comparable.(2)1 After 1 week of treatment,the TC values of group A and group B were lower than that before treatment(P<0.01),and the group A was significantly lower than group B(P<0.05);After 5 weeks of treatment,the TC values of group A and group B were lower than that at week 1(P<0.05),and there was no significant difference in TC value between the 5 groups at week two(P>0.05).2 1 weeks after treatment,the TG values of group A and group B were lower than that before treatment(P<0.01),there was no significant difference between the AB group(P>0.05);After 5 weeks of treatment,the TG values of AB group were lower than that at week 1(P<0.05),and there was no significant difference between the two groups at the end of the week(P>0.05).3 After 1 week treatment,the LL-C value of AB groups were lower than that before treatment,the difference was statistically significant before and after treatment(P<0.01),the LL-C value of A group was significantly lower than that of B group,there was significant difference(P<0.01);After 5 weeks of treatment,The LDL-C in group A was slightly higher than that in 1 week(P> 0.05),which was significantly lower than that before treatment(P <0.05).LDL-C in group B decreased compared with 1 week(P <0.05).There was no significant difference in LDL-C between AB at 5 weeks.4 There was no significant difference in HDL-C value between the two groups before and after treatment and between the two groups AB.5 In group A,1 patients had recurrent cerebral infarction,and B group had no recurrence.There was no significant difference in recurrence rate between the two groups(P>0.05).(2)1 After treatment,4 cases of group A showed an increase in liver enzyme(3 times> AST or ALT> 2 times),1 case of group A showed a significant increase in liver enzyme(AST or ALT>3 times),1 case of group A showed a significant increase in muscle enzymes.A total of 6 patients had adverse reactions(12%).1 case of group B showed an increase in liver enzyme(3 times> AST or ALT> 2 times),1 case of group B showed a significant increase in muscle enzymes,and 1 case of group B showed muscle pain(After withdrawal,the patient`s symptoms were significantly alleviated),.A total of 3 patients had adverse reactions(7%).There was no significant increase in creatinine by renal function tests in the two groups before and after treatment.The adverse reaction rate of A group was higher than that of B group,but there was no significant difference between the two groups(P>0.05).2 Some patients in the group had slightly higher liver enzyme(AST or ALT<2 times),but still continued strengthen lipid-lowering therapy.1 week or 5 weeks after treatment,the liver enzymes returned to normal,no sustained or increased hepatotoxicity.3 In this study,78 patients were non-diabetic and completed the whole course of treatment and follow-up,40 in group A,38 in group B.There was no significant difference in fasting blood glucose between the two groups before and after treatment in the AB group(P>0.05).And there was no new diabetes appeared after treatment in the two groups.(3)6 cases(10.5%)of group B gave up the treatment because of poor compliance with unauthorized withdrawal and reduction in the course of treatment in the group A.14 cases(24.6%)of group B gave up treatment because of poor compliance.The compliance of group A was better than that of group B(P <0.05).Conclusions 1.Rosuvastatin 20 mg and atorvastatin 60 mg can effectively reduce the blood concentration of TC,TG,LDL-C,But there is no significant effect on HDL-C.2.When using rosuvastatin and atorvastatin at a dose of 1:3 for the intensive lipid-lowering treatment,the effect of rosuvastatin is better than that of atorvastatin in the short term.,The long-term lipid-lowering effect ot the two kinds of medicine are almost the same.There is no significant difference between the two kinds of medicine in the second level prevention of cerebral infarction.3.The percentage of adverse reactions of rosuvastatin is higher than that of atorvastatin,but there is no significant difference.4.The medicine-taking compliance of rosuvastatin is better than that of atorvastatin. |
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