阿托伐他汀与辛伐他汀治疗急性脑梗死的临床对照研究

Clinical control study of atorvastatin and simvastatin in the treatment of acute cerebral infarction

目的比较阿托伐他汀与辛伐他汀对急性脑梗死患者血脂、神经功能的影响。方法 60例急性脑梗死患者,随机分为阿托伐他汀组和辛伐他汀组,每组30例。两组患者均予以抗血小板聚集等常规治疗,阿托伐他汀组在常规治疗基础上加用阿托伐他汀口服,辛伐他汀组在常规治疗基础上加用辛伐他汀口服,治疗并随访90 d。比较两组患者治疗前、治疗后90 d的血脂、美国国立卫生研究院卒中量表(NIHSS)评分的变化。结果治疗前两组患者总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)及NIHSS评分比较差异无统计学意义(P>0.05)。治疗后90 d,两组患者的TC、LDL-C、TG均较治疗前明显降低(P<0.05),阿托伐他汀组各指标降低程度显著优于辛伐他汀组(P<0.05);阿托伐他汀组治疗后90 d HDL-C较治疗前及治疗后的辛伐他汀组明显升高(P<0.05);辛伐他汀组治疗后90 d HDL-C与治疗前比较差异无统计学意义(P>0.05)。治疗后90 d两组患者的NIHSS评分均较治疗前明显降低,且阿托伐他汀组NIHSS评分为(4.82±1.66)分,低于辛伐他汀组的(6.32±2.01)分,差异有统计学意义(P<0.05)。结论常规剂量的阿托伐他汀与辛伐他汀均能降低急性脑梗死患者的TC、LDL-C、TG和NIHSS评分,减轻神经功能缺损,改善临床预后,但相同剂量的阿托伐他汀较辛伐他汀的临床疗效更显著。阿托伐他汀有升高HDL-C的作用。

Objective To compare the effect of atorvastatin and simvastatin on blood lipids and neurological function in patients with acute cerebral infarction. Methods A ttoal of 60 acute cerebral infarction patients were randomly divided into atorvastatin group and simvastatin group, with 30 cases in each group. Both groups received conventional therapy of antiplatelet aggregation, and atorvastatin group also received oral administration of atorvastatin. Simvastatin group received oral administration of simvastatin, and were treated and followed-up for 90 d. Comparison were made on changes in blood lipids and the National Institutes of Health Stroke scale（NIHSS） score before treatment and at 90 d after treatment between two groups. Results Before treatment, both groups had no statistically significant difference in total cholesterol（TC）, low-density lipoprotein cholesterol（LDL-C）, triglyceride（TG）, high-density lipoprotein cholesterol（HDL-C） and NIHSS score（P〉0.05）. After 90 d of treatment, both groups had lower TC, LDL-C and TG than before treatment（P〈0.05）. Atorvastatin group had obviously better decline degree than simvastatin group（P〉0.05）. After 90 d of treatment, atorvastatin group had obviously higher HDL-C than before treatment and simvastatin group after treatment（P〈0.05）. After 90 d of treatment, simvastatin group had no statistically significant difference in HDL-C than before treatment（P〈0.05）. After 90 d of treatment, both group had obviously lower NIHSS score than before treatment, and atorvastatin group had lower NIHSS score as（4.82±1.66） points than（6.32±2.01） points in simvastatin group. Their difference was statistically significant（P〈0.05）. Conclusion The conventional dose of atorvastatin and simvastatin can lower TC, LDL-C, TG and NIHSS score in patients with acute cerebral infarction, reduce neurological deficit and improve clinical outcomes, bt the same dose of atorvastatin provides more remarkable clinical efficacy than simvastatin. Atorvastatin has an elevated HDL-C effect. Atorvastatin has the effect of increasing HDL-C.