氯吡格雷联合强化阿托伐他汀治疗脑梗死患者颈动脉粥样硬化斑块的效果观察

Effect of clopidogrel combined with intensive atorvastatin in treatement of carotid atherosclerotic plaque in patients with cerebral infarction

目的探讨氯吡格雷联合强化阿托伐他汀对脑梗死患者颈动脉粥样硬化斑块、血脂水平和治疗效果的影响。方法选取2013年10月～2016年5月期间我院收治的107例脑梗死患者，采用随机数字表法分为观察组（n=53）和对照组（n=54）。观察组患者采用氯吡格雷联合强化阿托伐他汀治疗，对照组患者采用氯吡格雷联合常规阿托伐他汀治疗。比较两组患者的治疗有效率和治疗前后的颈动脉内中膜厚度（IMT）、斑块面积变化、超敏C-反应蛋白（hs—CRP）及血脂变化。结果治疗后，两组患者的IMT和斑块面积均显著减小，观察组患者的IMT和斑块面积小于对照组，差异有统计学意义（P〈0．05）；观察组患者的hs—CRP、甘油三酯（TG）、胆固醇（TC）、低密度脂蛋白-胆固醇（LDL—C）和对照组患者的hs-CRP、TC均显著降低，观察组患者的高密度脂蛋白-胆固醇（HDL—C）则明显升高，观察组患者的hs—CRP、TG、TC、LDL—C小于对照组，HDL—C大于对照组，差异有统计学意义（P〈0．05）；两组患者的PAI-1、FIB显著降低，t—PA明显升高，观察组患者的PAI一1、FIB小于对照组，t-PA大于对照组，差异有统计学意义（P〈0．05），观察组患者的治疗有效率大于对照组，差异有统计学意义（P〈0．05）。结论相对于氯吡格雷联合常规阿托伐他汀治疗，强化阿托伐他汀更有助于改善脑梗死患者颈脂代谢异常、控制动脉硬化和抑制炎症反应，从而提高临床疗效。

Objective To investigate the effect of intensive clopidogrel combined with intensive atorvastatin on carotid atherosclerosis plaque, blood lipid level and treatment effect of patients with cerebral infarction. Methods 107 patients with cerebral infarction in our hospital from October 2013 to May 2016 were randomly divided into observation group （n=53） and control group （n=54）.Patients in observation group were treated with clopidogrel combined with atorvastatin treatment,and patientsin control group were treated with clopidogrel combined with conventional atorvastatin treatment.The effective rate of the treatment and carotid intima-media thickness （IMT）,plaque area change,high sensitive C- reactive protein （hs-CRP）,blood lipid changes before and after the treatment were analyzed and compared. Results After treatment,the IMT and plaque area of the two groups were significantly decreased,IMT and plaque area of observation group were less than those of control group,and the differences were statistically significant（P 〈0.05）.The hs-CRP,TG,TC,LDL-C of observation group and the hs-CRP,TC of control group were significantly decreased,the HDL-C of observation group was significantly increased,the hs- CRP,TG,TC,LDL-C of observation group were less than those of control group,the HDL-C of observation group was greater than that of control group,and the differences were statistically significant（P 〈0.05）.The PAI-1 and FIB of the two groups were decreased,the t-PA was increased significantly,the PAI-1,FIB of observation group were less than those of control group,the t-PA of observaiton group was greater than that of control group,and the differences were significantle different （P 〈0.05）.The effective rate of observation group was greater than that of control group,and the difference was statistically significant（P 〈 0.05）. Conclusion Compared with clopidogrel combined with conventional atorvastatin treatment,intensive atorvastatin is more helpful to improve the neck fat metabolism in patients with cerebral infarction,to control the arterial stiffness and inhibition of inflammatory responses,and to improve the clinical efficacy.