大剂量辛伐他汀强化治疗对缺血性脑血管病患者血脂水平及CVR的影响

目的探讨对缺血性脑血管病患者实施大剂量辛伐他汀强化治疗，分析治疗后其血脂水平的变化以及对脑血管储备能力（CVR）的影响。方法选取2013年7月至2015年2月就诊的174例缺血性脑血管疾病患者，随机分为大剂量组、常规剂量组和对照组。给予对照组患者抗凝、降纤、营养神经、扩血管等常规治疗，配合口服拜阿司匹林0．1g8d，于餐前适量水送服，根据患者病情给予溶栓治疗。在对照组治疗基础上给予常规治疗组患者辛伐他汀10mg／次，1次／d。在对照组治疗基础上给予大剂量组患者辛伐他汀40mg／次，2次／d。三组患者的治疗时间为2个月。观察3组患者治疗前后血脂水平及CVR。结果治疗前大剂量组、常规剂量组与对照组的血脂水平比较差异无统计学意义（P〉0．05）．具有可比性；治疗后，三组患者的血脂水平均得到改善，但大剂量组的总胆固醇（TC）、低密度脂蛋白胆固醇（LDL—C）、甘油三酯（TG）水平明显低于常规剂量组和对照组，高密度脂蛋白胆固醇（HDL—C）水平明显高于常规剂量组和对照组，差异具有统计学意义（P〈0．05）。治疗前，大剂量组、常规剂量组与对照组的屏气指数（BHI）及CVR比较差异无统计学意义（P〉0．05），具有可比性；经过治疗，大剂量组的BHI及CVR均明显高于常规剂量组与对照组，差异具有统计学意义（P〈0，05）。而常规剂量组与对照组间差异不明显。结论对缺血性脑血管病患者实施大剂量辛伐他汀强化治疗，有助于调节患者血脂指标水平的改变，改善CVR，促进脑缺血性损伤的恢复，值得临床推广。

Objective To analyze the changes of blood lipid level and cerebrovascular reserve capacity in ischemic cerebrovascular disease patients treated by high-dose simvastatin. Methods A total of 174 patients with ischemic cerebrovascular disease who were recruited from our hospital between July 2013 and February 2015 were randomly divided into three groups, namely high dose group, conventional dose group and control group. Patients of the control group were treated with anticoagulation, fibrinolytic, vessel dilatation, nourishing nerve and other conventional treatment, as well as oral administration of 0.1 g/d aspirin before meal. Thrombolytic therapy was given according to patient＇s condition. Patients of the conventional disc treatment received 10 mg/d simvastatin, in addition to conventional treatment. Patients of the high dose group were given 40 mg simvastatin, twice per day, in addition to conventional treatment. All patients in the three groups were treated for two months. Their blood lipid level and cerebrovascular reserve capacity were observed before and after treatment.Results Blood lipid levels showed no significant difference among three groups before treatment, data were comparable （ P〉0.05 ） . After 2-month treatment, blood lipid levels of patients in the three groups were improved. Total cholesterol （ TC ） , low-density lipoprotein cholesterol （ LDL-C ） and triglyceride （ TG ） levels in high dose group were significantly lower, while high-density lipoprotein cholesterol （HDL-C） level was significantly higher, compared with that in conventional dose group and control group （ P〈0.05 ） . Before treatment, breath holding index （ BHI ） and cerebrovascular reserve capacity （ CVR ） showed no significant difference among three groups, data were comparable （P〉0.05 ） . After treatment, BHI and CVR in high dose group were significantly higher than that in conventional dose group and control group （ P〈0.05 ） . The difference was not significant between conventional dose group and control group.Conclusion High- dose simvastatin enhancement treatment can regulate blood lipid level, improve cerebrovascular reserve capacity, promote the recovery after cerebral ischemic injury, and it is a potential clinical treatment for ischemic cerebrovascular disease patients.