Effect Of Different Doses Of Statins On Symptomatic Middle Cerebral Artery Stenosis And The Influence Of Cerebral Autoregulation

Objective: To study the effect of different doses of statins on symptomatic middle cerebral artery stenosis and the influence of cerebral blood flow autoregulation.Methods: 100 patients with unilateral symptomatic middle cerebral artery stenosis who were admitted to the First Affiliated Hospital of Hebei North University from March 2019 to June2020 were included.They were randomly divided into moderate intensity treatment group(50 cases)and high intensity treatment group(50 cases).After admission,they were given the general treatment recommended by the guidelines,including anti platelet aggregation,targeted treatment for common chronic diseases such as hypertension,improved the monitoring of cerebral blood flow autoregulation on both sides of the healthy and the patients,and recorded the corresponding phase difference and gain for comparison.Moderate intensity treatment group: atorvastatin treatment,the treatment dose is a single oral 20 mg,once a night,lasting for half a year.High intensity treatment group: the dose of atorvastatin was doubled,i.e.a single oral dose of 40 mg,also lasting for half a year,once a night.After 14 days of treatment,a variety of indicators including liver function and creatine kinase were monitored in the above-mentioned moderate and highintensity treatment groups.Finally,a total of 93 subjects completed the clinical study.Among them,7 subjects(7%)were out of the group due to obvious abnormal laboratory indicators(and)or myalgia,including 2 in the moderate intensity treatment group and 5 in the high-intensity treatment group.In order to evaluate the efficacy of different doses of atorvastatin calcium tablets in patients with symptomatic middle cerebral artery stenosis,the blood lipid level and inflammatory degree of the patients before and after the treatment in half a year,the dynamic cerebral blood flow monitoring of the affected side before and after the treatment in 3months and 6 months,and the NIHSS score and m Rs score at each time point during the observation period were compared objective to evaluate the prognosis of patients and analyze the relationship between dynamic cerebral autoregulation and prognosis,so as to provide new treatment guidance for ischemic stroke.Results:(1)Basic information of patients:there was no statistically significant difference in basic information and monitoring indicators including age,hypertension,coronary heart disease,liver and kidney function,creatine kinase,blood lipid level,degree of inflammatory reaction between the two groups(P > 0.05).(2)Comparative analysis: for the two groups of patients receiving treatment,the phase difference between the patients before and after treatment and the healthy side showed significant difference,but the difference between the two gain(P > 0.05)was not statistically significant.(3)Curative effect observation:a: After half a year of treatment,TC,TG,LDL-C,hs-CRP and other indicators of patients in medium intensity treatment group and high intensity treatment group were significantly decreased,HDL-C were higher than before,and the effect of lipid-lowering and anti-inflammatory effect of high intensity treatment group was stronger than that of medium intensity treatment group,the above effect was significant(P < 0.01);b: For medium intensity treatment group,the effect of high intensity treatment group was better than that of medium intensity treatment group the phase difference gradually increased with the increase of treatment time,and the increasing trend was significant(P < 0.01);for the patients in the high-intensity treatment group,the phase difference after 3 months of treatment was significantly higher than that before treatment,and also significantly higher than that in the patients in the medium intensity treatment group after 3months of treatment(P < 0.01).After 6 months of treatment,the phase difference tended to be stable or even decreased,and there was no significant difference between the two groups(P > 0.05).Although there were differences in the gain before and after 6 months of treatment in the moderate intensity treatment group,there were no significant differences in the gain within or between the other groups(P > 0.05);c: Comparing the NIHSS and m Rs scores of the moderate intensity treatment group and the high intensity treatment group at 3 and 6 months,it was found that both of them decreased to varying degrees,and the score of the high intensity treatment group decreased after 3 months of treatment compared with the medium intensity treatment group,the decreasing trend was more obvious(P < 0.05);d: The NIHSS score and m Rs score of patients with relative preservation of d CA(phase difference > 40 °)were significantly lower than those with obvious impairment of d CA before treatment,indicating that the neurological damage was mild,while the prognosis of patients with relative preservation of d CA(phase difference > 40 °)was more significant after treatment;(4)There was no death or cerebral hemorrhage in the two groups,and adverse reactions occurred in the high-intensity treatment group the treatment rate was significantly higher than that of moderate intensity treatment group.Conclusion: 1.Before treatment,the d CA in the affected side of patients with symptomatic middle cerebral artery stenosis was significantly damaged,while that in the healthy side was retained.2.The patients with symptomatic middle cerebral artery stenosis were significantly damaged in d CA before drug treatment,and the function of d CA of the affected side was recovered after medium intensity and high intensity atorvastatin calcium treatment.The effect of high intensity treatment group was more significant than that of medium intensity treatment group in a short time.3.In the clinical treatment of patients with symptomatic middle cerebral artery stenosis,the short-term use of highintensity dose of statins can be reduced to medium intensity dose to continue the maintenance treatment,which not only has the best effect on improving the d CA function of the affected side,but also can effectively inhibit the occurrence of adverse events,that is to achieve the significant improvement of drug safety,and reduce the menstrual cycle for patients financial burden.4.The nerve function damage caused by the relatively reserved d CA function is lighter,which indicates a better prognosis.When the d CA function is obviously damaged,the nerve function damage is serious,which indicates a poor prognosis.In clinical treatment,the d CA function should be restored as soon as possible,so as to provide guarantee for the prognosis of patients and improve the quality of life.