HEART's Original [臨床研究] 大動脈弓部における非石灰化プラークはアテローム血栓性脳梗塞の再発に密接に関与する

背景:大動脈弓部における潰瘍性・可動性プラークの存在は,脳梗塞発症の危険因子と考えられている.HMGCoA還元酵素阻害薬(スタチン)は,脳梗塞の再発予防に有効であるとの報告がある.われわれは大動脈弓部プラークのさまざまな組織性状やスタチンの非投与が脳梗塞の再発に及ぼす影響を調査した.方法:急性期(発症後6±1日)に経胸壁,経食道,頸動脈エコーを施行し,アテローム血栓性脳梗塞と診断された51例を対象とした.全例に対し,脳卒中学会のガイドラインに準じた適切な抗血栓薬やスタチンの経口投与を開始した.遠隔期における脳梗塞の再発の有無を,文書による聞き取りで調査した(平均観察期間840日).急性期の臨床...

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Published in心臓 Vol. 40; no. 1; pp. 24 - 33
Main Authors 屋代, 祥典, 奥山, 英伸, 石野, 光則, 久保田, 功, 金子, 一善, 結城, 孝一, 廣野, 摂
Format Journal Article
LanguageJapanese
Published 公益財団法人 日本心臓財団 15.01.2008
Subjects
HMG-CoA還元酵素阻害薬
大動脈弓部プラーク
脳梗塞
長期予後
Online AccessGet full text
ISSN0586-4488
2186-3016
DOI10.11281/shinzo1969.40.1_24

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Abstract 背景:大動脈弓部における潰瘍性・可動性プラークの存在は,脳梗塞発症の危険因子と考えられている.HMGCoA還元酵素阻害薬(スタチン)は,脳梗塞の再発予防に有効であるとの報告がある.われわれは大動脈弓部プラークのさまざまな組織性状やスタチンの非投与が脳梗塞の再発に及ぼす影響を調査した.方法:急性期(発症後6±1日)に経胸壁,経食道,頸動脈エコーを施行し,アテローム血栓性脳梗塞と診断された51例を対象とした.全例に対し,脳卒中学会のガイドラインに準じた適切な抗血栓薬やスタチンの経口投与を開始した.遠隔期における脳梗塞の再発の有無を,文書による聞き取りで調査した(平均観察期間840日).急性期の臨床所見と長期予後を詳細に比較検討した.結果:51例中15例(29%)に脳梗塞の再発または死亡を認めた.イベント発生群と非発生群における年齢,心内血栓,頸動脈プラークの合併頻度に差はなかった.イベント発生群は非発生群に比し,弓部における非石灰化プラークの合併頻度が高い傾向があり(100%vs78%,p=O.0865),スタチンの投与率は有意に低かった(7%vs36%,p=0.0411).非石灰化プラークを有する43例に限定して行った解析では,スタチン非投与群のイベント発生率は投与群に比し高い傾向を認めた( 44%vs 9%, p=0.0649) . 非石灰化プラークを有する症例における, 脳梗塞再発の子を,Cox比例ハザードモデルを用いて多変量解析したところ,スタチン非使用は独立した再発の危険因子であることが示された(オッズ比=20.965,95%Cl=1.143-384.512,P=0.0403).結語:大動脈弓部にみられる非石灰化プラークは脳塞栓再発の重要な危険因子であり,慢性期におけるスタチンの非投与は,非石灰化プラークを有する症例の再発率をさらに高める可能性が示唆された.
AbstractList 背景:大動脈弓部における潰瘍性・可動性プラークの存在は,脳梗塞発症の危険因子と考えられている.HMGCoA還元酵素阻害薬(スタチン)は,脳梗塞の再発予防に有効であるとの報告がある.われわれは大動脈弓部プラークのさまざまな組織性状やスタチンの非投与が脳梗塞の再発に及ぼす影響を調査した.方法:急性期(発症後6±1日)に経胸壁,経食道,頸動脈エコーを施行し,アテローム血栓性脳梗塞と診断された51例を対象とした.全例に対し,脳卒中学会のガイドラインに準じた適切な抗血栓薬やスタチンの経口投与を開始した.遠隔期における脳梗塞の再発の有無を,文書による聞き取りで調査した(平均観察期間840日).急性期の臨床所見と長期予後を詳細に比較検討した.結果:51例中15例(29%)に脳梗塞の再発または死亡を認めた.イベント発生群と非発生群における年齢,心内血栓,頸動脈プラークの合併頻度に差はなかった.イベント発生群は非発生群に比し,弓部における非石灰化プラークの合併頻度が高い傾向があり(100%vs78%,p=O.0865),スタチンの投与率は有意に低かった(7%vs36%,p=0.0411).非石灰化プラークを有する43例に限定して行った解析では,スタチン非投与群のイベント発生率は投与群に比し高い傾向を認めた( 44%vs 9%, p=0.0649) . 非石灰化プラークを有する症例における, 脳梗塞再発の子を,Cox比例ハザードモデルを用いて多変量解析したところ,スタチン非使用は独立した再発の危険因子であることが示された(オッズ比=20.965,95%Cl=1.143-384.512,P=0.0403).結語:大動脈弓部にみられる非石灰化プラークは脳塞栓再発の重要な危険因子であり,慢性期におけるスタチンの非投与は,非石灰化プラークを有する症例の再発率をさらに高める可能性が示唆された.
Author 金子, 一善
久保田, 功
結城, 孝一
廣野, 摂
石野, 光則
屋代, 祥典
奥山, 英伸
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– reference: 31) Masuda J, Ogata J, Yutani C, et al: Artery-to-artery embolism from a thrombus formed in stenotic middle cerebral artery. Report of an autopsy case. Stroke 1987; 18: 680-684
– reference: 45) Lima JA, Desai MY, Steen H, et al: Statin-induced cholesterol lowering and plaque regression after 6months of magnetic resonance imaging-monitored therapy. Circulation 2004; 110: 2336-2341
– reference: 46) Yonemura A, Momiyama Y, Fayad ZA, et al: Effect of lipid-lowering therapy with atorvastatin on atherosclerotic aortic plaques detected by noninvasive magnetic resonance imaging. J Am Coll Cardiol 2005; 45: 733-742
– reference: 8) Amarenco P, Bogousslaysky J, Callahan A 3rd, et al: Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators: High-dose atorvastatin after stroke or transient ischemic attack. N Engl J Med 2006; 355: 549-559
– reference: 17) North American Symptomatic Carotid Endarterectomy Trial Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with highgrade carotid stenosis. N Engl J Med 1991; 325: 445-453
– reference: 41) Rasmussen LM, Hansen PR, Nabipour MT, et al: Diverse effects of inhibition of 3-hydroxy-3methylglutaryl-CoA reductase on the expression of VCAM-1 and E-selectin in endothelial cells. Biochem J 2001; 360: 363-370
– reference: 20) Lee RJ, Bartzokis T, Yeoh TK, et al: Enhanced detection of intracardiac sources of cerebral emboli by transesophageal echocardiography. Stroke 1991; 22: 734-739
– reference: 18) De Bray JM, Baud JM, Dauzat M, et al: Consensus concerning the morphology and the risk of carotid plaques. Cerebrovasc Dis 1997; 7: 289-296
– reference: 44) Okazaki S, Yokoyama T, Miyauchi K, et al: Early statin treatment in patients with acute coronary syndrome: demonstration of the beneficial effect on atherosclerotic lesions by serial volumetric intravascular ultrasound analysis during half a year after coronary event: the ESTABLISH Study. Circulation 2004; 110: 1061-1068
– reference: 1)生活習慣病予防協会・編: 2001生活習慣病のしおり. 東京: 社会保険出版社; 2001
– reference: 22) Di Tullio M, Sacco RL, Venketasubramanian N, et al: Comparison of diagnostic techniques for the detection of a patent foramen ovale in stroke patients. Stroke 1993; 24: 1020-1024
– reference: 30) Masuda J, Yutani C, Ogata J, et al: Atheromatous embolism in the brain: a clinicopathologic analysis of 15autopsy cases. Neurology 1994; 44: 1231-1237
– reference: 48) Sever PS, Dahlof B, Poulter NR, et al; ASCOT investigators: Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet 2003; 361: 1149-1158
– reference: 43) Nissen SE, Tuzcu EM, Schoenhagen P, et al; REVERSAL Investigators: Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA 2004; 291: 1071-1080
– reference: 4)近藤礼, 小久保安昭, 嘉山孝正: 平成17年に登録された脳卒中症例のまとめ. 山形県対脳卒中治療研究会誌2006; 16: 31-32
– reference: 14)脳卒中治療合同ガイドライン委員会・編: 2-1危険因子の管理と再発予防. 脳卒中治療ガイドライン. 2004. p. 59-60
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Snippet 背景:大動脈弓部における潰瘍性・可動性プラークの存在は,脳梗塞発症の危険因子と考えられている.HMGCoA還元酵素阻害薬(スタチン)は,脳梗塞の再発予防に有効であるとの報...
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StartPage 24
SubjectTerms HMG-CoA還元酵素阻害薬
大動脈弓部プラーク
脳梗塞
長期予後
Title HEART's Original [臨床研究] 大動脈弓部における非石灰化プラークはアテローム血栓性脳梗塞の再発に密接に関与する
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Volume 40
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ispartofPNX 心臓, 2008/01/15, Vol.40(1), pp.24-33
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