| OBJECTIVEAtherosclerosis (atherosclerosis, AS) is cerebrovascular disease, especially arteriosclerosis cerebral infarction important pathologic basis. The internal carotid artery and vertebrobasilar arteries that two brain artery blood system occurring at different positions of the atherosclerosis will lead to the corresponding nervous missing symptoms and signs. The intracranial arteries is point to more than double side of independent arcade carotid artery, vertebral artery and its gives more than the intracranial arteries. The intracranial atherosclerosis is systemic atherosclerosis in the aortic arch local show. Its pathological mechanism, risk factors, intervention methods are similar to other parts of the atherosclerosis. Because of the particular position of the evaluation method, but also has its own characteristics. Modern medicine for the disease at present major therapeutic agents include:inhibition of platelet aggregation, statins, antioxidant, anti-inflammatory agents and other drugs. The current study of the atheromatous plaque is more concentrated in the coronary artery, for intracranial and extracranial atherosclerosis, particularly intracranial arteriosclerosis plaque of still relatively little. Therefore, study on the fusion of different interventions on intracranial and extracranial arteriosclerosis plaque effect, helps to provide basis for prevention and cure of cerebral vascular disease.Traditional Chinese medicine have no extracranial atherosclerotic corresponds to the disease name description, but in intracranial and extracranial arteriosclerosis as pathological basis of induced brain ischemic changes and showed clinical symptoms can be attributed to the Chinese "stroke","vertigo","dementia","headache" etc. Ancient traditional Chinese medicine on the pathogenesis of deficiency of Qi and blood stasis phlegm is wraparound for, stagnation of phlegm and blood stasis is the key of its pathology. Modern Chinese medicine literature studies show, intracranial and extracranial atherosclerosis is due to blood stasis, phlegm, pathogen caused by this standard is false certificate. Treatment mainly by activating blood circulation to dissipate blood stasis, tonifying the liver and kidney, resolving phlegm and freeing channels, clearing away heat and toxic material mainly. Although activating blood circulation to dissipate blood stasis in treatment of traditional Chinese medicine in the treatment of intracranial and extracranial arteriosclerosis has unique advantages, is expected to be clinically to reduce cerebral vascular accident.This paper on the basis of clinical observation, through cerebral vessels CTA before and after treatment in patients with extracranial carotid artery, vertebral artery extracranial and intracranial artery stenosis comparison, analysis. The different position of the arterial stenosis and related risk factors and intervention of drugs (especially Chinese promoting blood circulation and removing blood stasis herbal medicine) for analysis, Study of intracranial and extracranial arteriosclerosis plaque development, change rule; The clinical incidence of ischemic stroke and associated risk factors and intervention of drug analysis, to explore the effective methods in prevention and treatment of ischemic stroke.METHODAll selected90cases, that are in line with the Chinese medicine neuroscience, various types of cerebrovascular disease diagnosis cerebral thrombosis diagnosis,1996of the State Administration of traditional Chinese Medicine Department of medicine in emergency coordination group:stroke diagnosis and curative effect evaluation criteria of disease diagnosis standard. According to therapeutic drug or Chinese herbal medicine which can be divided into traditional Chinese medicine in the group and traditional Chinese medicine in traditional Chinese medicine in the group, the group a total of53patients; no Chinese participation in the group in37cases. During treatment were recorded before and after treatment of arterial stenosis, stenosis rate change value, intracranial arteriosclerosis plaque distribution, endpoint observation, serum inflammatory factor, safety index. The90patients taking the drug were:aspirin enteric-coated tablets of0.1QD; atorvastatin10-20mg QN; clopidogrel75mg QD; herbs of promoting blood circulation to remove blood stasis.All patients before and after treatment by using GE Lightspeed16CT layer, the first routine scan, CTA scan range of independent arterial arch to the cranial crest. Observation of carotid artery, vertebral artery intracranial, outer plaque brachytherapy location, size and cavity flow signal filling, and calculate the rate of vascular stenosis.The observation of intracranial brain, artery stenosis distribution. Using a Nikon S210digital camera, in the manual mode to surface reconstruction phase acquisition, Bilateral internal carotid artery was collected respectively, lateral image; bilateral vertebral artery, lateral image; Both sides of the brain, sagittal and coronal3D imaging of intracranial arteries. Using Photoshop CS5.0image processing software on internal carotid artery stenosis measurement, using the inside diameter reduction on internal carotid artery, vertebral artery stenosis severity quantification, Stenosis rate=(stenosis of the proximal normal arterial lumen diameter-narrow residual inner diameter)/stenosis of the proximal normal arterial lumen diameter x100%; Stenosis rate change value (%)=after treatment of stenosis rate (%)-before treatment of stenosis rate (%).Arterial stenosis degree evaluation:According to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method to determine the degree of vascular stenosis. For the internal carotid artery and vertebral artery stenosis severity evaluation is divided into:①The narrow range of most serious:bilateral stenosis rate②The average rate of restenosis:the mean stricture rate=summary of bilateral stenosis/2. Intracranial artery stenosis distribution:according to the bilateral anterior cerebral artery after, in, and the basilar artery were statistical distribution. End event:each of the patients during the treatment of cerebral vascular accident records.The primary efficacy index:Artery stenosis rate change value:Stenosis rate change value (%)=stenosis rate after treatment (%)-stenosis rate before treatment (%); Deterioration:after treatment of stenosis rate; before treatment rate of restenosis; Improved:after treatment of stenosis rate before treatment rate of restenosis.Using SPSS17.0statistical software for recording and analysis system.Count data using mean±SD representation. For count data within group comparisons using the method of paired comparison of t test; For count data were compared between groups using independent samples t test; For count data in multiple groups were compared using analysis of variance. The dependent variable as class data, using a number of Logistic regression analysis; Two count data the correlation analysis between using bivariate correlation analysis. P=0.05there is significant difference.RESULT4groups of extracranial carotid artery hardening effect without obvious difference; platelet antagonists+promoting blood circulation and removing blood stasis on extracranial segment of vertebral artery arteriosclerosis plaque is superior to platelet antagonist plus atorvastatin; Platelet antagonist combined with atorvastatin and blood activating and stasis removing Chinese medicine for intracranial arteriosclerosis of the curative effect of platelet antagonists.Traditional Chinese medicine in the groups with traditional Chinese medicine in the group of extracranial arteriosclerotic plaque effect without obvious difference; traditional Chinese medicine in the group for intracranial artery stenosis effect is better than traditional Chinese medicine in the group.Clopidogrel and atorvastatin reduces carotid sclerosis exacerbations process; clopidogrel can delay the extracranial segment of vertebral artery arteriosclerosis aggravating process; Aspirin, clopidogrel, atorvastatin can delay intracranial arteriosclerosis aggravating process.Hypertension can accelerate the extracranial carotid artery atherosclerosis development process; coronary heart disease will accelerate the extracranial segment of vertebral artery atherosclerosis development process; intracranial arteriosclerosis hypertension will accelerate the development process.Traditional Chinese medicine in the group for serum angiotensin, serum high sensitive C reactive protein reducing action of traditional Chinese medicine in the group were better than those without.Extracranial segment of vertebral artery stenosis rate of change of the regression equation:Y=0.007+0.002X (Note:Y:extracranial segment of vertebral artery stenosis rate of change; X:treatment time); time and extracranial carotid artery stenosis and intracranial stenosis changes were unrelated to changes. Extracranial carotid artery stenosis changes of the regression equation:Y4.74+0.72X1+1.063X2-2.195X3(Note:Y:extracranial carotid artery stenosis changes;X1:age; X2:whether hypertension; X3:whether clopidogrel use of extracranial carotid arterial stenosis changes:0=better,1=worse). Extracranial segment of vertebral artery stenosis changes of the regression equation:Y-2.529+0.68X1+1.156X2-1.226X3-1.05X4(Note:Y:extracranial segment of vertebral artery stenosis changes; XI:time; X2:whether the hypertension; X3:whether the use of atorvastatin; X4:whether clopidogrel extracranial segment of vertebral artery stenosis changes:0=better,1=worse). Intracranial arterial stenosis and changes in the regression equation:Y=-0.163-1.112X1-1.095X2(Note:Y:intracranial artery stenosis changes; X1:atorvastatin; X2:clopidogrel intracranial artery stenosis changes:0=better,1=worse).Traditional Chinese medicine in the groups with traditional Chinese medicine in the group at the end of the incidence of cerebrovascular events aspects had significant differences, Chinese medicine to participate in group reduces the incidence of cerebrovascular events.Cerebrovascular accident incidence and related factors of the regression equation: Y=-2.933+0.059X1+0.916X2-0.984X3-1.187X4-0.724X5(Note:Y:cerebrovascular accident rate; X1:age; X2:whether diabetess; X3:whether to use aspirin; X4: whether to use clopidogrel; X5:whether to use blood activating and stasis removing Chinese medicine).DISCUSSIONThis research adopts the spiral CT cerebral angiography for the evaluation of means, the intracranial and extracranial artery divided into extracranial carotid artery, vertebral artery extracranial and intracranial arterial three parts separately carries on the related risk factors and the efficacy evaluation study, in order to reflect the different intervention factors on arch artery and intracranial arteries effect.This study showed that, blood activating and stasis removing Chinese medicine to different position of intracranial and extracranial arteriosclerosis plaque effect of different. Which of(extracranial carotid artery, vertebral artery extracranial arteriosclerosis plaque) effect is smaller, than the control group did not show a difference; On intracranial atherosclerotic effect than the control group showed no differences, is better than that of blood activating and stasis removing Chinese medicine group. The combination of different drugs also reflects the traditional Chinese medicine in the combination mode of the extracranial segment of vertebral artery and intracranial arteriosclerosis plaque development has slowed down effect. Possible reason:(1) Inadequate sample size (2) Short observation time (3) Study of drug types is complex (4) Intracranial and extracranial artery differences in different position.Clopidogrel in this experiment reflects on the intracranial and extracranial arteriosclerotic plaques have each stability and reducing effect, although its with aspirin to clopidogrel platelet antagonists, but unique protective effect may be caused by vascular intima of carotid atherosclerosis plaque is the primary influence; Hypertension carotid extracranial, intracranial arteriosclerosis risk factors; But coronary heart disease is the vertebral artery extracranial, intracranial arteriosclerosis risk factors, not found in diabetic and intracranial and extracranial atherosclerotic plaque development; Due to sample size limitations, the time and the different location of intracranial and extracranial arterial plaque and the relationship between failed to draw the same conclusion; The same factors, in different locations of arteriosclerotic process showed a different degree of participation. Possible reason:(l)Extracranial intracranial arterial sclerosis of the same risk factors and intervention factors in the reaction have different.(2) Due to the limitation of statistical method.Some in the intracranial and extracranial artery stenosis rate of change impact factors associated with not on ischemic cerebrovascular events plays a role; Instead, whether or not they have diabetes, whether aspirin, blood activating and stasis removing Chinese medicine on ischemic cerebrovascular events impact.Consideration should be given to different types of ischemic stroke causes induced by different.The results of this study show, Although the Chinese herbal medicine on intracranial and extracranial arteriosclerosis plaque changes showed no apparent stability and reducing effect, but through statistical analysis, it reduced ischemic cerebrovascular events recurrence rate, it is in arteriosclerotic cerebral infarction secondary prevention plays a role. The Chinese herbal medicine with clopidogrel, atorvastatin, combined traditional Chinese and Western medicine can further reduce the rate of recurrence of cerebral infarction. About it for intracranial and extracranial arteriosclerosis plaque of we should further expand the sample volume, extended observation period, detailed study of drug. This is not done within a short time, and hope that in future work to do further study.CONCLUSIONTraditional Chinese medicine in the group for intracranial artery stenosis effect is better than traditional Chinese medicine in the group; Clopidogrel and atorvastatin reduces carotid sclerosis exacerbations process; Clopidogrel can delay the extracranial segment of vertebral artery arteriosclerosis aggravating process; Aspirin, clopidogrel, atorvastatin can delay intracranial arteriosclerosis aggravating process. Traditional Chinese medicine in traditional Chinese medicine in the group is the group reduces the incidence of cerebrovascular events; Cerebrovascular accident incidence and cerebrovascular accident incidence related factors of the regression equation: Y=-2.933+0.059X1+0.916X2-0.984X3-1.187X4-0.724X5(Note:Y:cerebrovascular accident rate; X1:age; X2:whether diabetess; X3:whether to use aspirin; X4: whether to use clopidogrel; X5:whether to use blood activating and stasis removing Chinese medicine). |
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