他汀类药物对脑梗死患者血清C反应蛋白及预后的影响

Effect of statins on serum C-reactive protein(CPR)and prognois in patients with cerebral infarction

目的探讨血清C反应蛋白(Creactiveprotein,CRP)及血脂水平与脑梗死病情严重性及预后的关系,进而了解他汀类药物对脑梗死患者血清CRP水平及预后的影响。方法采用随机、双盲、安慰剂对照的方法进行研究,将46例脑梗死患者分为对照组及辛伐他汀组(辛伐他汀40mg/d或阿托伐他汀20mg/d,连续用药7d)。治疗前后检测血清CRP、血脂、血清谷草转氨酶(AST)及血清肌酸激酶(CK)水平,应用美国国立卫生研究院卒中量表(NIHSS)及Barthel指数(BI)记分法对入选患者在入院时及3个月时的神经功能缺损程度进行评分。结果治疗前CRP水平与当时及3个月时病情显著相关(P<0.01,P<0.05),血脂水平则无此相关性。治疗后他汀组CRP水平下降,治疗前后的差值与对照组相比,差异有显著性(P<0.01)。各组入院时神经功能缺失程度评分与3个月后相比,差异有显著性(P<0.01),但不同组之间相比无明显差别。治疗后各组AST及CK水平无明显变化。结论脑梗死患者血清CRP水平与病情的严重性及预后相关。短期应用他汀类药物可以降低脑梗死患者血清CRP水平,安全性好,但对梗死后3个月的预后无明显改善作用。他汀类药物对脑梗死的疗效需要进一步研究。

Objective To study the relationship between serum CRP, serum lipids and severity, prognosis of cerebral infarction, and to study effect of statins on CRP levels and prognosis. Methods Forty-six cerebral infarction patients were divided by random, double-blind, placebo contrasstive method into the control group and statins group （40 mg/d of simvastatin or 20 mg/d of atorvastatin for 7 days）. The serum levels of CRP, lipids, aspartate aminotransferase （AST） and creatine kinase （CK） were detected before and after treatment. All patients were examined with National Institutes of Health Stroke Scale （NIHSS） and Barthel Index （BI） score at admission and 3 months after admission. Results The levels of serum CRP were correlated significantly with severity and prognosis of cerebral infarction （P 〈 0. 05）, but serum lipids were not correlated. The levels of serum CRP in statins group significantly decreased compared with those in control group （ P 〈 0.01 ）. Though neurological functional deficit scales in the two groups were significantly improved after 3 months （ P 〈 0.01 ）, there were no statistical differences in changes between groups. AST and CK levels had no changes after treatment. Conclusion The levels of serum CRP are. associated with severity and can predict prognosis of cerebral infarction. Statins can rapidly and safely reduce serum CRP, but there is no significant improvement in neurological functional deficit scales. The efficacy of statins in the treatment of cerebral infarction need to be studied further.