最新的證據(jù)提示現(xiàn)有最好的藥物治療可能足以預(yù)防無(wú)癥狀性頸動(dòng)脈狹窄患者卒中的發(fā)生。如果真是這樣的，那么確定治療所降低的風(fēng)險(xiǎn)就顯得至關(guān)重要。為此，英國(guó)圣喬治大學(xué)卒中與癡呆研究中心的Alice King博士等人進(jìn)行了一項(xiàng)研究，研究結(jié)果于近日在線(xiàn)發(fā)表在Stroke雜志上。結(jié)果發(fā)現(xiàn)：抗血小板治療和血壓控制是降低無(wú)癥狀頸動(dòng)脈狹窄患者短期卒中和心血管風(fēng)險(xiǎn)的最重要因素。

　　該研究為無(wú)癥狀性頸動(dòng)脈栓塞研究（ACES）前瞻性數(shù)據(jù)，用來(lái)確定現(xiàn)有治療的效果和以后卒中或TIA的危險(xiǎn)因素。研究人員對(duì)477位無(wú)癥狀性頸動(dòng)脈狹窄的患者隨訪(fǎng)2年（每6個(gè)月隨訪(fǎng)1次）。每次隨訪(fǎng)危險(xiǎn)因素的改變，并了解卒中預(yù)防止療方案。使用時(shí)間依賴(lài)Cox回歸確定現(xiàn)有治療隨著時(shí)間推移，與卒中、短暫性腦缺血發(fā)作和心血管死亡終點(diǎn)的相關(guān)性，以風(fēng)險(xiǎn)比和95%可信區(qū)間來(lái)表示。

　　研究結(jié)果顯示：在多變量分析中，抗血小板藥物(P=0.001)和較低的平均血壓(P=0.002)是單側(cè)卒中和短暫性腦缺血發(fā)作風(fēng)險(xiǎn)降低的獨(dú)立預(yù)測(cè)因素。抗血小板藥物(P<0.0001)和降壓藥(P<0.0001)是所有卒中和心血管死亡風(fēng)險(xiǎn)降低的獨(dú)立預(yù)測(cè)因素。

　　該研究發(fā)現(xiàn)：抗血小板治療和血壓控制是降低無(wú)癥狀頸動(dòng)脈狹窄患者短期卒中和心血管風(fēng)險(xiǎn)的最重要因素。目前用于無(wú)癥狀性頸動(dòng)脈狹窄的藥物（特別是他汀類(lèi)），需要的更多的前瞻性數(shù)據(jù)進(jìn)行驗(yàn)證。

　　The Effect of Medical Treatments on Stroke Risk in Asymptomatic Carotid Stenosis

　　Alice King, PhD, Martin Shipley, MSc, Hugh Markus, FRCP, for the ACES Investigators

　　Background and Purpose—Recent evidence suggests current best medical treatment may be sufficient to prevent stroke in patients with asymptomatic carotid stenosis. If this is the case, then it is important to determine risk reduction provided by treatments. Using Asymptomatic Carotid Emboli Study (ACES) prospective data, the effect of current treatment and risk factors on future stroke and transient ischemic attack risk were determined. Methods—Four-hundred seventy-seven patients with asymptomatic carotid stenosis were followed-up every 6 months for 2 years. Changes in risk factors and stroke prevention therapies were reviewed at each visit. Using time-dependent Cox regression, the relationship between current treatment over time was determined and presented as hazard ratios and 95% confidence intervals for risk of stroke, transient ischemic attack, and cardiovascular death end points. Results—On multivariate analysis, antiplatelets (P=0.001) and lower mean blood pressure (P=0.002) were independent predictors of reduced risk of ipsilateral stroke and transient ischemic attack. Antiplatelets (P<0.0001) and antihypertensives (P<0.0001) were independent predictors of a lower risk of any stroke or cardiovascular death. Conclusions—Antiplatelet therapy and blood pressure control are the most important factors in reducing short-term stroke and cardiovascular risk in patients with asymptomatic carotid stenosis. More prospective data are required for medical treatments in asymptomatic carotid stenosis in particular for current statin usage.