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目的针对他汀类药物预防缺血性卒中的高质量证据、可能机制、安全性以及现状前景进行综述。方法结合他汀类药物预防缺血性卒中不同临床试验研究情况,具体分析他汀类药物,在预防缺血性卒中中的作用机制及药物的安全性。结果他汀类药物在临床应用中已得到广泛认可,对于有缺血性卒中/TIA的患者,应尽早完善血脂检查,基线LDL-C>2.6mmol/L患者,建议他汀类药物治疗,将LDL-C降至2.6mmol/L以下,并定期监测血脂水平。对确有大动脉粥样硬化证据,或有动脉-动脉栓塞证据的缺血性卒中/TIA极高危患者和伴有多种危险因素的缺血性卒中/TIA的极高危患者(伴有冠心病/糖尿病/不能戒断吸烟/代谢综合征之一者),均推荐强化他汀治疗,应将LDL-C降至2.1mmol/L以下,或LDL-C降低幅度在40%以上,并定期监测血脂水平。结论他汀类药物的疗效在临床应用中已经得到认可,在心血管病的一级和二级预防中已取得显著效果,近年在缺血性卒中的防治中也逐渐受到重视。但从治疗的效果及安全性角度考虑有必要进行个性化治疗,在保证有效性同时减少药物副作用。
Objective To summarize the high quality evidence, possible mechanisms, safety and current situation of statins in preventing ischemic stroke. Methods Combined with statins to prevent ischemic stroke in different clinical trials, the specific analysis of statins, the mechanism of action in the prevention of ischemic stroke and drug safety. Results Statins have been widely recognized in clinical practice. Patients with ischemic stroke / TIA should be as soon as possible to improve blood lipids, baseline LDL-C> 2.6mmol / L patients, the proposed statin therapy, the LDL- C to 2.6mmol / L or less, and regular monitoring of blood lipid levels. Patients with very high risk of developing atherosclerotic evidence or evidence of arterial-arterial embolization at very high risk for ischemic stroke / TIA and ischemic stroke / TIA with multiple risk factors (with coronary heart disease / Diabetes / can not quit smoking / metabolic syndrome), are recommended for statin therapy, LDL-C should be reduced to 2.1mmol / L or less, or LDL-C decreased by more than 40%, and regular monitoring of blood lipid levels. Conclusion The efficacy of statins has been recognized in clinical application. It has achieved remarkable results in the primary and secondary prevention of cardiovascular diseases. In recent years, it has also been paid more attention in the prevention and treatment of ischemic stroke. However, considering the effect of treatment and safety, it is necessary to carry out personalized treatment, so as to ensure the effectiveness and reduce side effects of drugs.