| Objective: To observe the effect of atorvastatin combined with probucol on restenosis after vertebral artery stenting and to investigate the effect on the high sensitive C-reactive protein(hs-CRP)and oxidized low density lipoprotein(ox-LDL).And to evaluate the efficacy of atorvastatin combined with probucol in patients after vertebral artery stenting compared with monotherapy of atorvastatin.In addition,we evaluate the safety of the two drugs in clinical application and the effect of combined treatment on the prevention of ischemic cerebrovascular disease.Methods: A total of 60 proximal atherosclerotic extracranial vertebral artery stenosis patients underwent stent implantation at the third hospital of Xingtai City were enrolled consecutively between January 2016 and June 2016 prospectively.The patients were randomly divided into group A(Atorvastatin group)and group B(Combined treatment group),with 30 cases in each group.All of the patients were given health education,smoking cessation and limiting alcohol,dietary guidance and improving the lifestyle,while giving control of blood pressure,blood glucose and other conventional treatment.Group A received monotherapy of atorvastatin 20 mg QN,while group B received combined treatment of atorvastatin calcium 20 mg QN and probucol 0.5g BID.All the patients were followed up for 6 months.At postoperation,1,3,6 months after operation,the restenosis was evaluated by cervical ultrasonography.In addition,the levels of serum lipid,high sensitive C-reactive protein(hs-CRP)and oxidized low-density lipoprotein(ox-LDL)in peripheral blood were tested.During the follow-up,the liver function,renal function and electrocardiogram(ECG)were monitored,and adverse events were recorded.1 Comparison of restenosis rates after stent implantationThe restenosis rate was 10%(3/30)and 6.89%(2/29)in group A and group B respectively at 3 months after operation,but there was no statistically significant difference.The restenosis rates were 20%(6/30)and 10.34%(3/29)respectively at 6 months after operation.The rate of restenosis after stenting in group B was significantly lower than that in group A(P<0.05).2 Comparison of recurrence rate of stroke incidentAt the follow-up of 6 months after operation,there were 3 cases of stroke incident in group A and no recurrence of stroke in group B,the difference was statistically significant(P<0.05).3 Comparison of the levels of hs-CRP and ox-LDLThe levels of hs-CRP and ox-LDL in the peripheral blood of the patients were observed at postoperation and 1,3 and 6 months after operation.The results showed that after 6 months of treatment,compared with pretreatment,the levels of serum hs-CRP were reduced at different degrees in the two groups.Compared with group A,the levels of hs-CRP and ox-LDL in group B were significantly decreased(P<0.05).4 Changes of serum lipid levelsComparison in group: Compared with pretreatment,the levels of TC,TG and LDL-C in the two groups were significantly decreased(P<0.05),and the levels of HDL in group A were significantly higher(P<0.05),but HDL levels in group B had no significant change compared with pretreatment(P>0.05).Comparison among two groups: The levels of TC,TG,LDL-C,HDL in the two groups before treatment were not significantly different(P>0.05),while after 6 months of treatment,the levels of TC,TG,LDL-C and HDL in group B were significantly lower than those in group A(P<0.05).5 Drug safety evaluation of atorvastatin combined with probucolDuring the follow-up,the liver function,renal function and electrocardiogram were monitored,and adverse events were recorded.The incidence of adverse events in group A and B was 13.3% and 10.3%,respectively.There were 4 patients in group A and 3 patients in group B Results: appeared mild elevation of liver enzymes,but elevation <3 times of the normal value.Statistical results showed that the incidence of adverse events between the two groups was not statistically significant(P>0.05)6 Comparison of general data between restenosis group and non-restenosis group after 6th month follow-upAccording to the general data,we found smoking is the dependent risk factor of in-stent restenosis.And the combined treatment of atorvastatin and probucol decreases the morbidity of restenosis.7 Multivariate Logistic regression analysisWe analysis the related risk factors via multivariate logistic regression and our findings show that combined treatment can attenuate the in-stent restenosis while smoking is a risk factor for it.Conclusions: For patients after vertebral artery stenting,the treatment of atorvastatin combined with probucol has anti-inflammatory and antioxidant effects,and can significantly regulate blood lipid levels in patients with preventing the occurrence and development of atherosclerosis.In addition,the combined treatment can effectively reduce the rate of restenosis after vertebral artery stenting,thus prevents the recurrence of ischemic cerebrovascular disease.And its incidence of adverse drug events did not significantly increase compared with the monotherapy of atorvastatin,so the combined treatment is safe and reliable,and is worthy of clinical promotion. |
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