小檗碱对脑梗死患者颈动脉粥样硬化斑块稳定性及血清基质金属蛋白酶-9和氧化低密度脂蛋白的影响

Effect of berberine on stability of carotid atherosclerotic plaque and serum matrix metalloproteinases-9,oxidized low density lipoprotein in patients with cerebral infarction

目的探讨小檗碱对脑梗死患者颈动脉粥样硬化斑块稳定性及血清基质金属蛋白酶-9(MMP-9)及氧化低密度脂蛋白(ox-LDL)的影响。方法选取2015年12月-2016年8月首次以颈动脉粥样硬化型脑梗死住院的患者100例,将其随机分为对照组和小檗碱组各50例。对照组给予基础治疗,小檗碱组在对照组基础上给予口服盐酸小檗碱片0.5g,每日3次连续口服6个月。均在入院治疗时和治疗后3及6个月抽取静脉血,采用酶联免疫吸附测定法检测血清中ox-LDL和MMP-9的水平;同时全自动生化仪测定血浆中总胆固醇(TC)、三酰甘油(TG)和低密度脂蛋白胆固醇(LDL-C)水平;入院时和治疗后3及6个月行颈动脉彩超测颈动脉内膜-中层厚度(IMT)积分、粥样斑块Crouse积分及低回声斑块个数;采用日常生活能力表(BI)评分量表评价神经功能。结果①治疗后,两组不同时间点间的IMT积分(F=5.762,P=0.004)、斑块Crouse积分(F=6.661,P=0.002)、不稳定斑块个数(F=12.139,P=0.000)、TC(F=15.707,P=0.000)、TG(F=9.748,P=0.000)、LDL-C(F=5.805,P=0.004)、ox-LDL(F=4.460,P=0.013)、MMP-9(F=7.933,P=0.001)及神经功能BI指数(F=13.555,P=0.000)差异有统计学意义。②小檗碱组与对照组的IMT积分(F=4.301,P=0.041)、斑块Crouse积分(F=3.981,P=0.049)、不稳定斑块个数(F=4.773,P=0.031)、TC(F=5.104,P=0.022)、TG(F=5.047,P=0.027)、LDL-C(F=5.593,P=0.020),ox-LDL(F=4.409,P=0.038)、MMP-9(F=4.184,P=0.043)及神经功能BI指数(F=4.733,P=0.032)差异有统计学意义,且小檗碱组各指标改善程度优于对照组。结论小檗碱具有稳定及缩小颈动脉粥样硬化斑块、降血脂、降低血清氧化低密度脂蛋白及基质蛋白酶-9,改善神经功能的作用。

cholesterol （LDL-C） were measured by automatic biochemical analyzer; carotid intima-media thickness （IMT）, crouse score of atherosclerotic plaque and the number of unstable plaque were measured by carotid color Doppler ultrasound. Before and 3 months and 6 months after treatment for, the neural function defect scale was scored by Barthel Index （BI）. Results After treatment, compared with the control group of different time points, differences of carotid artery intima media thickness IMT score （F = 5.762, P = 0.004）, crouse score of atherosclerotic plaque （F= 6.661, P= 0.002）, the number of unstable plaque （F= 12.139, P= 0.000）, TC （F = 15.707, P= 0.000）, TG （F=9.748, P= 0.000）, LDL-C （F= 5.805, P= 0.004）, ox-LDL （F=4.460, P=0.013）, MMP-9 （F=7.933, P= 0.001）, and neural function Barthel Index （BI） （F= 13.555, P= 0.000） were significant. The carotid artery intima media thickness IMT score （F= 4.301, P= 0.041）, the crouse score of atherosclerotic plaque （F= 3.981, P= 0.049）, the number of unstable plaque （F= 4.773, P= 0.031）, TC （F= 5.104, P= 0.022）, TG （F= 5.047, P=0.027）, LDL-C （F= 5.593, P=0.020）, ox-LDL （F= 4.409, P=0.038）, MMP-9 （F= 4.184, P= 0.043）, and neural function Barthel Index （BI） （F= 4.733, P= 0.032） of the berberine group and the control group were different, and the improvement degree of berberine group was superior to the control group. Conclusions Berberine has effects on stabilizing and reducing carotid atherosclerotic plaque, lowering blood fat, antioxidation, reducing matrix metalloproteinases-9 and oxidized low density lipoprotein, improving the neurological function.