| Background: Statins can significantly reduce the recurrence of atherosclerotic acute ischemic stroke.High intensity statins are recommended for clinical initiation in foreign guidelines,but the benefits and safety of the maximum allowable dose of statins in Chinese populations are uncertain.High resolution magnetic resonance imaging(MRI)of intracranial vascular wall can be used to evaluate the effect of drug therapy on atherosclerosis.Objective: The patients with acute atherosclerotic ischemic stroke were treated with different intensities of Atorvastatin,and high resolution intracranial vascular wall magnetic resonance imaging(MRI)was used as an evaluation method.To compare the imaging parameters of the responsible vascular vulnerable plaque before and after treatment,to explore the better statins intensity in the treatment of symptomatic intracranial atherosclerosis,and to provide the basis for the clinical application of high resolution intracranial vascular wall magnetic resonance imaging technology.Method: The patients were randomly divided into moderate intensity group(Atorvastatin 20mg/ day)and high intensity group(Atorvastatin 40mg/ day).The patients were given 3.0T craniocerebral MRI,DWI,MRA,within 2 weeks of onset and 6 months after taking drugs.HR-VW-MR imaging(DANTE-SPACE technique)was used to evaluate vascular stenosis,wall area,remodeling rate and plaque enhancement.To compare whether the plaque was reversed and the degree of reversal was different between the two groups.Statistical software using SPSS 22.0 statistical analysis software package.Result: 45 patients were included in this study,among which 21 cases were in the moderate intensity group and 24 cases in the high intensity group.During the follow-up,25 cases fell off,6 cases did not reach the time of follow-up,finallycomplete the follow-up of patients with moderate intensity group of 10 cases and 4cases in the high intensity group.Fourteen patients who were followed up by doctors were monitored for liver biochemistry,myocardial enzyme spectrum,no hepatic enzyme and creatine kinase elevation in the 1,3,6 months after taking the medicine.Comparison between the two groups,there were no significant statistical differences in age,sex,stroke risk factors(hypertension,diabetes,hyperlipidemia,smoking index),laboratory tests(fasting blood glucose,glycosylated hemoglobin,hypersensitive C-reactive protein,erythrocyte sedimentation rate,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,homocysteine)and responsible vascular imaging parameters(vascular stenosis,remodeling rate,lumen area,plaque enhancement)(P > 0.05).After 6 months of regular administration,laboratory tests(fasting blood glucose,glycosylated hemoglobin,hypersensitive C-reactive protein,erythrocyte sedimentation rate,total cholesterol,triglyceride,high-density lipoprotein cholesterol,low-density lipoprotein cholesterol,and homocystine)were performed no significant statistical difference between the two groups.(P > 0.05).In the moderate intensity group,the hypersensitive C-reactive protein,erythrocyte sedimentation rate,total cholesterol were lower than before and high density lipoprotein cholesterol was higher than before,and the difference was statistically significant(P < 0.05).The low density lipoprotein cholesterol,hypersensitive C-reactive protein and erythrocyte sedimentation rate in the high intensity group were significantly lower than those before,and the difference was statistically significant(P < 0.05).There was no significant statistical difference in the imaging parameters of responsible vessels inter-group and intra-group(vascular stenosis,remodeling rate,lumen area,plaque enhancement)(P > 0.05).The correlation analysis between the general data and the imaging parameters of atherosclerosis showed that total cholesterol and the hypersensitive C-reactive protein were positively correlated with the area of vessel wall(P < 0.05),but not with the degree of vascular stenosis,the degree of plaque enhancement,and the rate of remodeling(P > 0.05).Low density lipoprotein cholesterol was positively correlated with plaqueenhancement(P < 0.05),but not with vascular stenosis,wall area and remodeling rate(P > 0.05).There was no correlation between fasting blood glucose,glycosylated hemoglobin,erythrocyte sedimentation rate,triglyceride,low density lipoprotein cholesterol,high density lipoprotein cholesterol,homocysteine,smoking index,history of hypertension,age and degree of vascular stenosis,wall area,remodeling rate,and degree of plaque enhancement(P > 0.05).Conclusion: The moderate and high intensity atorvastatin could obviously improve the inflammatory response of intracranial atherosclerotic plaque and stabilize the plaque,but there was insufficient evidence to reverse the plaque.Long-term,regular use of statins is necessary for ischemic stroke patients. |
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