阿托伐他汀联合尤瑞克林治疗急性脑梗死疗效观察及对内皮素、炎性因子的影响

The clinical efficacy and influence of atorvastatin and urinary kallidinogenase on endothelin and inflammato-ry mediators in the treatment of elderly patients with acute cerebral infarction

目的：观察阿托伐他汀联合尤瑞克林治疗急性脑梗死患者的临床疗效及对血液流变学、内皮素、炎性因子的影响，指导临床合理治疗。方法将86例急性脑梗死患者按随机数字表法分为观察组43例和对照组43例，两组均进行常规方法治疗，对照组再给予阿托伐他汀治疗，阿托伐他汀钙20 mg／d，1次／d；观察组再给予阿托伐他汀联合尤瑞克林治疗，尤瑞克林0．15PNA ／次，2周为1个疗程。治疗前后进行神经功能缺损评分（NIHSS 评分）与日常生活能力量表（ADL）评分，空腹抽血检测内皮素、CRP、IL-1水平，测定血液流变学指标，进行疗效评价。结果观察组和对照组治疗后全血高切黏度、红细胞聚集指数、红细胞比容、纤维蛋白原、红细胞沉降率、内皮素、CRP、IL-1、NHISS 评分分别为（3．45±0．21）mpa／s 和（4．89±0．31）mpa／s，（4.05±0.56）和（6．43±0.63），（33．4±3．4）％和（39．8±3．7）％，（2．43±0．72）g／mL 和（3．18±0．64）g／mL，（20．5±7．5）mm／h 和（27．3±7．3）mm／h，（58．8±5．7）pg／L 和（70．7±7．5）pg／L，（6．68±2．96）mg／L 和（16.78±8．97）mg／L，（3.64±1．56）ng／L 和（6．53±2．64）ng／L，（8．2±3．3）分和（15．5±6．3）分，均较治疗前明显降低，差异有统计学意义（t ＝5．234和4．267，4．627和3．532，4．872和3．726，5．021和3．429，6．046和3.848，10．477和6.818，11．557和6．686，9．267和6．421，12．712和5．044，均 P ＜0．05），ADL 评分分别为（28．7±11．2）分和（22．5±10．1）分，较治疗前明显升高，差异均有统计学意义（t ＝8．396和5．336，P ＜0.05），治疗后观察组全血高切黏度、红细胞聚集指数、红细胞比容、纤维蛋白原、红细胞沉降率、内皮素、CRP、IL-1、NHISS 评分明显低于对照组，差异均有统计学意义（t ＝3．207、3．388、3．667、3．761、3．959、3．929、3．884、3.304、3.778，均 P ＜0．05），ADL 评分明显高于对照组，差异有统计学意义（t ＝3．447，P ＜0．05）；观察组、对照组的总有效率分别为95．35％（41／43）、69．77％（30／43），差异有统计学意义（χ2＝10．904，P ＜0．05）。结论阿托伐他汀联合尤瑞克林治疗急性脑梗死患者的临床疗效确切，有效改善神经功能缺损评分，改善患者日常生活能力，其作用机制可能与降低内皮素、炎性因子水平、改善血液循环有关，值得临床推广使用。

Objective To observe the clinical efficacy and influence of atorvastatin and Urinary Kallidinoge-nase on rheology,endothelin and inflammatory mediators in the treatment of elderly patients with acute cerebral infarc-tion,and to guide clinical treatment.Methods 86 patients with acute cerebral infarction were randomly divided into 43 cases of the observation group and 43 cases of the control group.Both groups were given conventional therapy,then the control group were given atorvastatin（20mg/d,qd）,the observation group were given atorvastatin（20mg/d,qd） and Urinary Kallidinogenase（0.15PNA /time）.2 weeks were set for a course of treatment,NIHSS score and ADL score were calculated before and after treatment.Then endothelin,CRP,IL -1 and hemorheology were measured by phlebotomized when limosis to evaluated the efficacy.Results The high shear whole blood viscosity,erythrocyte ag-gregation index,hematocrit,fibrinogen,erythrocyte sedimentation rate,endothelin,CRP,IL -1 and NHISS of the ob-servation group and control group after treatment were respectively （3.45 ±0.21）mpa/s vs.（4.89 ±0.31）mpa/s, （4.05 ±0.56）vs.（6.43 ±0.63）,（33.4 ±3.4）% vs.（39.8 ±3.7）%,（2.43 ±0.72）g/mL vs.（3.18 ±0.64）g/mL,（20.5 ±7.5）mm/h vs.（27.3 ±7.3）mm/h,（58.8 ±5.7）pg/L vs.（70.7 ±7.5）pg/L,（6.68 ±2.96）mg/L vs.（16.78 ±8.97）mg/L,（3.64 ±1.56）ng/L vs.（6.53 ±2.64）ng/L,（8.2 ±3.3）point vs.（15.5 ±6.3）point. Data of both groups were significantly lower than before treatment,（t =5.234 vs.4.267,4.627 vs.3.532,4.872vs.3.726,5.021 vs.3.429,6.046 vs.3.848,10.477 vs.6.818,11.557 vs.6.686,9.267 vs.6.421,12.712 vs. 5.044,all P 〈0.05）.The ADL score were （28.7 ±11.2）point vs.（22.5 ±10.1）point,and the data of both groups were significantly higher than before treatment （t =8.396 vs.5.336,all P 〈0.05）.The high shear whole blood vis-cosity,erythrocyte aggregation index,hematocrit,fibrinogen,erythrocyte sedimentation rate,endothelin,CRP,IL -1 and NHISS of the observation group were significantly lower than the control group（t =3.207,3.388,3.667,3.761, 3.959,3.929,3.884,3.304,3.778,all P 〈0.05）.The ADL score of the observation group were significantly higher than the control group（t =3,447,P 〈0.05）;The total effective rate of the observation group and control group were 95.35% （41 /43 ）vs 69.77% （30 /43 ）,the difference was statistically significant （χ2 =10.904,P 〈0.05 ）. Conclusion The method contained atorvastatin and urinary kallidinogenase have exact clinical efficacy,can improve neurological deficit assessment and the ability of daily life.Its mechanism may be that it can reduce endothelin levels of inflammatory mediators and improve blood circulation,which is worthy of clinical use.