| Cerebrovascular disease(CVD)is a serious threat to human health,it has the characteristics of “high morbidity、high mortality、high disability and high recurrence rate”.In recent years,it has become the first cause of disability and death in China.In cerebrovascular disease,ischemic stroke accounts for 70%,and dyslipidemia is an important risk factor.Numerous clinical studies at home and abroad have found that lipid-lowering(LDL-C)therapy can reduce the incidence and risk of cerebrovascular disease events.For this reason,LDL-C is the primary goal of lipid-regulating therapy in domestic and foreign treatment guidelines for stroke treatment,and the goal of lipid-regulating treatment for patients with high and extreme risk of stroke is proposed.Although most guidelines specify the preferred statin drugs for lipid-lowering therapy,there are still a series of problems in clinical pratice,such as irregular lipid-lowering therapy,poor patient compliance,and low compliance rate of LDL-C after treatment.Objective:This study summarized and analyzed the patients with acute cerebral infarction who received moderate dose of statin and intensive lipid-lowering treatment at neurology department of the first hospital attached to Jilin University,in order to explore the feasibility of intensive lipid-lowering therapy in patients with acute ischemic stroke,and provided a reference for clinical lipid-lowering treatment.Methods:This study collected patients aged 40~80 years old who were hospitalized at the first hospital attached to Jilin University from November 2017 to October 2018 and diagnosed with acute cerebral infarction through CT / MRI.It is divided into intensive lipid-lowering group and moderate dose of statin group according to its statin dosage.The gender,age,and past medical history of the patients were counted,and serum lipid,adverse reactions and recurrence of cerebrovascular disease were followed up 1 and 3 months after discharge.The above statistics were summarized and analyzed.Results:(1)General data:A total of 182 patients were collected and divided into three groups : group A(moderate dose of statin group)there were 97 cases,of which 70 were men and 27 were women,the average age was 59.40±9.91 years old;group B(intensive lipid-lowering group)there were 73 cases,of which 50 were men and 23 were women,the average age was 58.59±8.52 years old;group C(continue to intensive lipid-lowering group)there were 12 cases,of which 5 were men and 7 were women,the average age was 61.17±7.89 years old.Because the number of cases in group C was too little and the differene between group C and group A and B was too large,only statistical description was conducted in group C,and there was no significant difference in baseline data such as age and gender between group A and group B.(2)Follow-up of serum lipid after discharge 1month: group A:follow-up LDL-C of 1 month:2.64±0.66mmol/L,LDL-C average delicine was 27%,LDL-C compliance number:6 cases(7.5%);group B:follow-up LDL-C of 1 month:2.34±0.55mmol/L,LDL-C average delicine was 34%,LDL-C compliance number:11 cases(20%).There was statistically significant difference between the group B and the group A in LDL-C level reduction,LDL-C average delicine,and LDL-C compliance number(P<0.05).(3)Follow-up of adverse reactions after discharge 1month:group A:41 cases(51.3%)of liver enzyme elevated and 2 case(2.5%)of myoenzymes elevated;group B:32 cases(58.2%)of liver enzyme elevated and 3 case(5.5%)of myoenzymes elevated.The proportion of liver enzymes and myoenzymes in group B was higher than that in group A,but there was no significant difference in adverse reactions between the two groups(P>0.05).(4)Comparison between combined lipid-lowering drugs and statin alone: Among the 74 patients,in group A whose LDL-C was not up to the standard at 1 month,40 patients participanted in the 3-month follow-up,of which,21 patients were regularly treated with moderate dose of statin for lipid-lowering therapy,and 19 patients were treated with moderate dose of statin+ezetimibe for lipid-lowering therapy;Among the 44 patients,in group B whose LDL-C was not up to the standard at 1 month,28 patients participanted in the 3-month follow-up,of which,13 patients were regularly treated with moderate dose of statin for lipid-lowering therapy,and 15 patients were treated with moderate dose of statin+ezetimibe for lipid-lowering therapy.The combined lipid-lowering drugs in group A and group B were compared with statin alone,there was no significant difference in the reduction of LDL-C level,LDL-C compliance number and adverse reaction events(P>0.05).(5)Recurrence of cerebrovascular disease events:A 3-month follow-up showed that 1 patient in group A and 1 patient in group B was hospitalized due to recurrence of cerebral infarction.(6)Follow-up of patient compliance:Follow-up compliance:156 patients were followed up at 1 month after discharge,accounting for 86% of the total number.A total of 117 patients were followed up at 3 months after discharge,accounting for 64% of the total patients.Drug compliance:142 patients were followed up at 1 month after discharge,taking lipid-lowering drugs regularly according to the prescribed dosage.Taking of traditional Chinese medicine:1 case,not taking medicine:10 cases,not following the prescribed dosage of medicine or reduce the dosage:3 cases;110 patients were followed up at 3 month after discharge,taking lipid-lowering drugs regularly according to the prescribed dosage.Taking of traditional Chinese medicine:1 case,not taking medicine:4 cases,not following the prescribed dosage of medicine or reduce the dosage:2 cases.Conclusions:(1)For patients with acute cerebral infartion with hyper LDL-emia,intensive lipid-lowering therapy was uesed in the acute phase,compared with the moderate dose of statin lipid-lowering therapy,the LDL-C level reduction was significantly reduced 1month after discharge,and LDL average delicine and LDL compliance number was significantly greater than the latter.(2)Although the proportion of liver enzymes and myoenzymes in intensive lipid-lowering therapy in the acute phase was higher than that in the moderate dose of statin lipid-lowering therapy,the difference between the two therapies was not statistically significant.(3)Restricted by too few samples,the combined lipid-lowering drugs(moderate dose of statin+ezetimibe)were compared with moderate dose of statin alone,there was no significant difference in the reduction of LDL-C level,LDL-C compliance number and adverse reaction events.(4)During the follow-up process,patients may stop taking or reducing drugs by themselves.Patients’ follow-up and drug compliance need to be improved. |
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