丁苯酞联合较高剂量阿托伐他汀治疗急性脑梗死临床观察

Clinical Observation of Butylphthalide Combined with High Dose Atorvastatin in Patients with Acute Cerebral Infarction

目的:观察丁苯酞联合较高剂量阿托伐他汀治疗急性脑梗死的疗效,及对患者炎性反应、氧化应激和动脉粥样斑块的影响。方法:146例急性脑梗死患者随机分为观察组和对照组各73例。对照组给予丁苯酞联合常规剂量阿托伐他汀治疗,观察组给予丁苯酞联合较高剂量阿托伐他汀治疗。评价两组治疗总有效率,比较两组患者治疗前后血浆同型半胱氨酸(Hcy)、C反应蛋白(CRP)、丙二醛(MDA)、超氧化物歧化酶(SOD)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、氧化修饰低密度脂蛋白(oxLDL)、基质金属蛋白酶-9(MMP-9)水平,和颈动脉内膜中层厚度(cIMT)、颈动脉粥样斑块面积、不稳定斑块数量变化情况。对Hey、MDA、斑块面积、不稳定斑块变化幅度与年龄、入院NHSS评分、脑梗死体积及丁苯酞联合降脂、联合一般降脂、联合强化降脂等指标的相关性进行分析。出院后进行3个月的预后随访。结果:治疗后观察组总有效率为81.2%,明显高于对照组的61.4%(P<0.05)。治疗后两组患者的Hcy、CRP、MDA、TC、TG、LDL、oxLDL、MMP-9、cIMT及颈动脉斑块面积、不稳定斑块数量等指标均较治疗前明显降低(P<0.05),SOD则较治疗前升高(P<0.05),且观察组各项指标均优于对照组(P<0.05)。Hcy、MDA、斑块面积、不稳定斑块变化值与丁苯酞联合降脂呈正相关,而与强化降脂的相关性更高(P<0.05)。观察组预后良好率明显优于对照组(P<0.05)。结论:丁苯酞联合阿托伐他汀强化降脂治疗急性脑梗死的效果明显,可有效改善患者炎性反应和氧化应激状态,有利于促进神经功能恢复和抑制动脉斑块形成。

Objective： To investigate the influences of butylphthalide combined with high dose atorvastatin on the curative effect,inflammatory reaction,oxidative stress and atheromatous plaques in patients with acute cerebral infarction. Methods： Totally 146 patients with acute cerebral infarction were randomly divided into the observation group and the control group. The patients in the control group were treated with butylphthalide combined with conventional dose atorvastatin,and the patients in the observation group were treated with butylphthalide combined with high dose atorvastatin. The total efficiency after the treatment,homocysteine（ Hcy）,C-reactive protein（ CRP）,malondialdehyde（ MDA）,superoxide dismutase（ SOD）,cholesterol（ TC）,triglyceride（ TG） and low-density lipoprotein cholesterol（ ldl-c）,oxidized low-density lipoprotein（ oxLDL）,matrix metalloproteinase-9（ MMP-9）,intima-media thickness of carotid artery（ cIMT）,atheromatous plaque area and unstable plaques were compared after the treatment between the groups.The correlations of Hcy,MDA,plaque area,unstable plaque with age,NIHSS score at admission,cerebral infarction volume and butylphthalide combined with lipid-lowering,butylphthalide combined with general lipid-lowering,and butylphthalide combined with intensive lipid-lowering were analyzed. The prognosis and adverse drug reactions were also recorded. Results： The total efficiency after the treatment in the observation group was 81. 2%,which was higher than that（ 61. 4%） in the control group,and the difference was statistically significant（ P〈0. 05）. Compared with those before the treatment,Hcy,CRP,MDA,TC,TG,LDL,oxLDL,MMP-9,cIMT atheromatous plaque area and unstable plaques after the treatment decreased（ P〈0. 05）,SOD increased（ P〈0. 05）,and the improvements in the observation group were significantly higher than those in the control group（ P〈0. 05）. The changes of Hcy,MDA,plaque area and unstable plaque were positively correlated with butylphthalide combined with atorvastatin,and high dose atorvastatin was related with Hcy,MDA,plaque area and unstable plaque more significantly than conventional dose atorvastatin. The prognosis of the observation group was significantly better than that of the control group（ P〈0. 05）. Conclusion： Butylphthalide combined with high dose atorvastatin has good curative effect on acute progressive cerebral infarction,which can effectively improve inflammatory reaction and oxidative stress,promote neural functional recovery and inhibit arterial plaque formation.