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《慢性病学杂志》[ISSN:1674-8166/CN:11-5900/R]

卷:

期数:

2018年11期

页码:

1484-1488

栏目:

论　著

出版日期:

2018-11-30

文章信息/Info

Title:

Clinical analysis of atorvastatin and rosuvastatin in the treatment of cerebral infarction

作者:

文洪波;  杨军;  孙树乾;  褚爱萍

南京市溧水区人民医院，南京211200

Author(s):

WEN Hong-bo;  YANG Jun;  SUN Shu-qian;  CHU Ai-ping

Nanjing Lishui People's Hospital, Nanjing 211200, China Corresponding author: CHU Ai-ping, E-mail：1839165730@qq.com

关键词:

阿托伐他汀; 瑞舒伐他汀; 脑梗死; 临床效果

Keywords:

Atorvastatin;  Rosuvastatin;  Cerebral infarction;  Clinical effect

分类号:

R743.33

DOI:

-

摘要:

目的探讨阿托伐他汀和瑞舒伐他汀对脑梗死患者血脂水平、炎症反应、颈动脉粥样硬化斑块以及神经 功能的影响，为临床治疗提供参考。方法选取2015 年5 月—2017 年5 月南京市溧水区人民医院收治的126 例 脑梗死患者，随机分为三组，每组42 例。A 组给予10 mg/d 阿托伐他汀联合100 mg/d 阿司匹林；B 组给予 20 mg/d 阿托伐他汀联合100 mg/d 阿司匹林；C 组给予10 mg/d 的瑞舒伐他汀联合100 mg/d 阿司匹林，三组 均连续治疗6个月。于治疗前后检测并比较三组颈动脉内膜中层厚度（IMT），同时记录患者的高、低回声斑块及 混合回声斑块数，观察并比较三组总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度 脂蛋白胆固醇（LDL-C）、白细胞介素1β （IL-1β）、白细胞介素6 （IL-6） 及肿瘤坏死因子-α （TNF-α） 以及 高敏C 反应蛋白（hs- CRP） 的水平。采用美国国立卫生研究院卒中量表（NIHSS） 及改良Rankin 量表 （mRS） 评估三组患者神经功能。记录患者转治疗期间不良反应的发生率。结果治疗后，三组TC、TG 及 LDL-C 均显著性降低（P＜0.05），而HDL-C 无显著性改变（P＞0.05）；B 组TC 水平显著性低于A 组，C 组 TC、TG 和LDL-C 水平均低于A 组，差异有统计学意义（P＜0.05）；治疗后，三组hs-CRP、IL-1β、IL-6 及 TNF-α 水平均显著低于本组治疗前，且B 组和C 组均明显低于A 组（P＜0.05）；治疗后，B 组和C 组IMT 分别 为（1.67±0.45）、（1.52±0.71） mm，与本组治疗前比较，差异有统计学意义（P＜0.05）。B 组低回声斑块显著性 降低，C 组混合回声斑块显著性降低。治疗后，三组NIHSS 和mRS 评分均显著低于本组治疗前，且B 组和C 组 均明显低于A 组（P＜0.05）。B 组及C 组患者的心血管不良事件总发生率低于A 组，且C 组低于B 组，差异均有 统计学意义（P<0.05）。结论他汀类药物可显著性降低脑梗死患者的血脂水平，降低炎症反应，逆转颈动脉粥 样硬化斑块以及改善神经功能，不良反应发生率低，并且20 mg/d阿托伐他汀和10 mg/d瑞舒伐他汀的效果优于 10 mg/d的阿托伐他汀。

Abstract:

Objective To investigate the effects of atorvastatin and rosuvastatin on blood lipid level, inflammatory response, carotid atherosclerotic plaque and nerve function in patients with cerebral infarction. Methods Totally 126 patients with cerebral infarction who were treated in Nanjing Lishui People's Hospital from May 2015 to May 2017 were randomly divided into 3 groups, 42 cases in each group. Group A was given 10 mg/d atorvastatin combined with 100 mg/d aspirin, group B was given 20 mg/d atorvastatin combined with 100 mg/d aspirin, and group C was given 10 mg/d rosuvastatin combined with 100 mg/d aspirin for 6 months. The carotid intima media thickness （IMT） was detectedin the 3 groups, and hyperechoic plaque, hypoechoic plaque and mixed echo plaque were recorded. Total cholesterol （TC） , triglyceride （TG） , high-density lipoprotein cholesterol （HDL-C） , low density lipoprotein cholesterol （LDL-C） , interleukin 1 beta （IL-1 beta） , interleukin 6 （IL-6） , tumor necrosis factor-alpha （TNF-α） , and high sensitive C reactive protein （hs-CRP） were detected. The National Institutes of Health Stroke Scale （NIHSS） and modified Rankin scale （mRS） were used to assess neurological function. The incidence of adverse reactions during treatment was recorded. Results After treatment, TC, TG and LDL-C decreased significantly （P<0.05） , but HDL-C did not change significantly in all three groups （P>0.05） ; the level of TC in group B, and the levels of TC, TG and LDL-C in group C were significantly lower than those in group A （P<0.05） . The levels of hs-CRP, IL-1β, IL-6 and TNF-α in group B and C were significantly lower than those in group A （P<0.05） . IMT levels in group B and group C were （1.67±0.45） , （1.52±0.71） mm after treatment, which were lowed than those before treatment （P<0.05） . The hypoechoic plaques in group Band mixed echo plaques in group C were significantly decreased after treatment （P<0.05） . After treatment, the scores of NIHSS and mRS in the three groups were significantly lower than those before treatment, especially in group B and group C. The incidences of cardiovascular adverse events in group B and group C were significantly lower than those in group A （P<0.05） , and the incidence of cardiovascular adverse events in group C was lower than that in group B （P<0.05） . Conclusion Statins can significantly reduce the level of blood lipid, lower the inflammatory response, reverse the carotid atherosclerotic plaque and improve the neurological function, and the incidence of adverse reactions is low. The effect of 20 mg/d atrovastatin and 10 mg/d rosuvastatin are superior to 10 mg/d atorvastatin.

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备注/Memo

备注/Memo:

作者简介：文洪波，硕士，副主任医师，研究方向：神经病学 通信作者：褚爱萍，E-mail：1839165730@qq.com

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更新日期/Last Update: 2018-11-30