强化他汀联合阿替普酶治疗急性脑梗死的临床观察

Clinical observation of alteplase combined with atorvastatin intensive in treatment of acute cerebral infarction

目的:探讨强化他汀联合阿替普酶在治疗急性脑梗死(ACI)中的应用价值。方法:选择2016-04—2017-12期间廉江市人民医院神经内科收治的ACI患者90例,采用随机数表法将患者分为观察组和对照组,每组45例。2组患者均采用阿替普酶溶栓。对照组入院后即刻给予20mg/d阿托伐他汀治疗,观察组则入院后即刻予80mg阿托伐他汀,入院第2天按40mg/d的剂量继续口服。评估两组的疗效。检测两组治疗前后的血脂水平、颈动脉粥样硬化情况和炎症因子浓度。统计两组的不良反应。结果:观察组的疗效明显好于对照组(P<0.05)。观察组治疗后1个月的总胆固醇、低密度脂蛋白胆固醇、甘油三酯、肿瘤坏死因子-α、高敏C反应蛋白和基质金属蛋白酶-9浓度均明显低于对照组(P<0.05);观察组治疗后6个月的颈动脉内膜中膜厚度、不稳定斑块数目和斑块面积均明显少于对照组(P<0.05)。观察组和对照组不良反应的发生率分别为8.89%和4.44%,差异没有统计学意义(P>0.05)。结论:采用阿替普酶联合强化他汀治疗ACI可提高疗效,同时又可有效控制患者的血脂水平、颈动脉粥样硬化和炎症因子浓度,而且不增加不良反应发生率。

Objective:To investigate the application of alteplase combined with atorvastatin intensive in treatment of acute cerebral infarction(ACI).Method:A total of ninety patients with ACI,who admitted to Department of Neurology of the People’s Hospital of Lianjiang from April 2016 to December 2017,were divided into the control group and the observation group,with 45 cases in each group.Two groups of patients were treated with alteplase.The control group was given 20 mg/d atorvastatin immediately after admission.The observation group received 80 mg atorvastatin immediately after admission,and second days after admission,the dosage was 40 mg/d.The curative effect of the two groups was evaluated.The levels of blood lipid,carotid atherosclerosis,inflammatory factor concentration were measured before and after treatment in two groups.The adverse reactions of the two groups were statistically analyzed.Result:The curative effect of the observation group was better than that of the control group(P<0.05).The total cholesterol,low density lipoprotein cholesterol,triglyceride,serum tumor necrosis factor-α,high sensitive C reactive protein and matrix metalloproteinase-9 concentrations of the observation group were significantly lower than those of the control group after 1 month treatment(P<0.05).The carotid intima media thickness,the number of unstable plaques and the plaque area of the observation group were significantly less than those of the control group after 6 month treatment(P<0.05).The incidence of adverse reactions in the observation group and the control group were 8.89% and 4.44%,and the difference was not statistically significant(P >0.05).Conclusion:The use of alteplase combined with atorvastatin intensive in treatment of ACI can improve the curative effect,and it also can effectively control the level of blood lipids,carotid atherosclerosis and inflammatory factors,while it does not increase the incidence of adverse reactions.