PAS疗法对脑梗死患者超敏C反应蛋白、同型半胱氨酸及颈动脉粥样硬化的影响

Effect of PAS therapy on serum high-sensitivity C-reactive protein plasma homocysteine and carotid atherosclerosis in cerebral infarction patients

目的探讨普罗布考、拜阿司匹林、阿托伐他汀联合(PAS)疗法对急性脑梗死患者血清超敏C反应蛋白(hs-CRP)、血浆同型半胱氨酸(Hcy)水平、颈动脉内膜中层厚度(IMT)及粥样硬化斑块的影响。方法分析135例初发脑梗死患者,随机分为对照组和PAS组,分别在入院后第2天及治疗后1个月清晨抽取患者空腹静脉血3 ml,采用酶免疫测定法测定血浆同型半胱氨酸水平;免疫比浊法测定血清hs-CRP水平;超声检测颈动脉IMT及斑块积分。结果对照组治疗1个月后血清hs-CRP水平明显低于治疗前(t=4.887,P=0.013);PAS组治疗1个月后血清hs-CRP水平明显低于治疗前(t=9.323,P=0.000);治疗1个月后PAS组血清hs-CRP水平明显低于对照组(t=3.326,P=0.004);对照组(t=1.670,P=0.212)、PAS组(t=0.978,P=0.449)治疗1个月后血浆Hcy水平与治疗前比较,差异无统计学意义;对照组治疗1个月后颈动脉IMT(t=2.987,P=0.031)及斑块积分(t=3.562,P=0.009)与治疗前比较明显下降;PAS组治疗1个月后颈动脉IMT(t=10.210,P=0.000)及斑块积分(t=8.756,P=0.000)与治疗前比较明显降低;治疗1个月后PAS组颈动脉IMT及斑块积分明显低于对照组(t=2.341,P=0.034;t=2.792,P=0.021)。结论 AS疗法(拜阿司匹林+阿托伐他汀)及PAS疗法对急性脑梗死患者具有明显的抗炎作用,PAS疗法优于AS疗法;PAS疗法对颈动脉粥样硬化具有治疗作用,而对血浆Hcy水平没有显著影响。

Objective To explore the effect of probucol, aspirin and atorvastatin （PAS） combination therapy on serum high-sensitivity C-reactive protein, plasma homocysteine, carotid intima-media thickness and plaque summary score in patients with acute cerebral infarction. Methods Total 135 patients with initial cerebral infarction were randomly divided into control group and PAS group. Fasting 3 ml venous blood was taken at the second day after admission and the first month after treatment. Enzyme immunoassay, immunoturbidimetrie assay and color doppler ultrasonic diagnostic apparatus were used to detect plasma homocysteine level, serum high-sensitivity C reactive protein level, and detect carotid intima-media thickness and plaque summary score respectively. Results High-sensitivity C reactive protein in the control group and the PAS group were significantly decreased at the first month, and high-sensitivity C reactive protein in the PAS group was significantly decreased than the control group at the first month. Plasma homocysteine has no significant difference at the first month. Carotid intima-media thickness and plaque summary score in the control group and PAS group were significantly decreased at the first month than that before treatment, and carotid intima-media thickness and plaque summary score in the PAS group was significantly decreased at the first month. Conclusions AS （aspirin＋atorvastatin） therapy and PAS therapy have significant anti-inflammatory effect on cerebral infarction patients. PAS therapy is superior to AS therapy in anti-inflammatory effects, and PAS therapy has a therapeutic effect on carotid atherosclerosist, but PAS therapy has no significant effect on plasma bomocysteine level with cerebral infarction patients.