沙利度胺对颈动脉粥样硬化疾病患者治疗的抗炎机制初探

The preliminary study on anti-inflammatory effects of thalidomide in patients with carotid atherosclerosis

目的探讨颈动脉粥样硬化(AS)患者应用沙利度胺治疗对血清炎性因子及血脂水平的影响。方法选择80例经颈动脉彩色超声证实有颈动脉粥样硬化的患者作为观察对象,随机分为治疗组和对照组,各40例。治疗组沙利度胺50mg·d-1,两组均给予肠溶阿司匹林75mg·d-1,同时,均予生活方式干预。均于治疗前及治疗后6个月测定血清炎性细胞因子肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)、超敏C反应蛋白(hs-CRP)和血脂水平,并观察颈动脉内中膜厚度(IMT)与斑块积分改变。结果治疗6个月后,治疗组血清TNF-α、IL-6、hs-CRP水平较对照组及治疗前均明显降低(P<0.05,P<0.01);治疗组IMT、斑块积分治疗后较对照组及治疗前均明显降低(P<0.05,P<0.01),治疗组中29.6%不稳定斑块转变为稳定斑块;血脂治疗前后未见明显变化(P>0.05)。结论沙利度胺可能通过下调血清炎性因子表达而非降脂效应抑制AS的进展。

Objective To study the influences of thalidomide on inflammatory cytokines and lipid level in patients with carotid atherosclerosis .Methods 80 patients diagnosed by color Doppler ultrasound with carotid artery plaques and abnormal IMT were randomly divided into treatment group and control group ,with each group 40 cases. The treatment group was given thalidomide 50mg · d-1 , both of the two groups were given enteric-coated aspirin 75mg· d-1 with a lifestyle intervention at the same time .The serum level of tumor necrosis factor-α（ TNF-α） , interleukin-6（ IL-6） , high sensitive C reactive protein （ hs-CRP ） and serum lipid were measured , and the carotid artery IMT, the plaque score and plaque changes were observed before and after treatment of six months .Results Compared with control group and with those before the treatment , the level of TNF-α, IL-6, hs-CRP in treatment group was decreased obviously after six months of treatment （P〈0.05,P〈0.01）,in which situation can also be found in the carotid IMT and the plaque score （ P〈0.05, P〈0.01 ） , and 29.6%of unstable plaques changed into stable plaques .Indexes of blood lipid in both of the two groups showed no significant changes before treatment and 6 months after treatment （ P〉0.05 ） .Conclusion Thalidomide can inhibit atherosclerosis by lowing the expression of inflammatory cytkines probably , which is no relative with lipid metabolism regulation .