瑞舒伐他汀钙两种不同疗法对大动脉粥样硬化型脑梗死患者颈动脉易损斑块疗效的评价

Evaluation of Two Different Therapies of Rosuvastatin Calcium Tablets on Vulnerable Carotid Plaques in Patients with Cerebral Infarction due to Large-artery

目的:比较强化剂量瑞舒伐他汀钙与标准剂量瑞舒伐他汀钙联合依折麦布对大动脉粥样硬化(Large-artery atherosclerosis,LAA)型脑梗死患者颈动脉易损斑块的疗效。方法:选取2016年1月到2019年2月在我科住院诊断为LAA型脑梗死的患者184例,按随机数字表分为对照组和观察组各92例。对照组给予强化剂量瑞舒伐他汀钙(20mg/晚),观察组给予标准剂量瑞舒伐他汀钙(10mg/晚)联合依折麦布(10mg/日),疗程12月。分别测量和检测两组患者服药前、服药3月、6月及12月颈动脉粥样硬化易损斑块的数目、体积、Crouse积分及血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-a(TNF-a)和基质金属蛋白酶-9(MMP-9)水平,试验结束时评价两组患者不良反应的发生率和依存性。结果:两组患者服药3月时易损斑块的数目、总斑块体积及Crouse积分与服药前比较无显著差异(P>0.05),服药6月及12月时均较服药前显著减低(P<0.05),观察组较对照组降低更显著(6月:P<0.05,12月:P<0.01);两组患者服药3月、6月、12月血清CRP、IL-6、TNF-a、MMP-9水平均较服药前显著降低(P<0.05),观察组与对照组在服药3月时血清CRP、IL-6、TNF-a、MMP-9水平比较无显著差异(P>0.05),服药6月和12月时比较,观察组较对照组降低更显著(6月:P<0.05,12月:P<0.01);不良反应比较:观察组肝功能异常、肌酸激酶升高、肌肉疼痛的发生率均显著低于对照组(P<0.05),腹泻的发生率显著高于对照组(P<0.05);观察组服药3月、6月时随访率与对照组比较无显著差异(P>0.05),服药12月时随访率显著高于对照组(P<0.05);观察组试验退出率明显低于对照组(P<0.05)。结论:标准剂量瑞舒伐他汀钙联合依折麦布对LAA型脑梗死患者颈动脉粥样硬化易损斑块的疗效较强化剂量瑞舒伐他汀钙好,不良反应发生率低,患者的依存性好,值得临床推广。

Objective:To compare the efficacy of enhanced rosuvastatin calcium with conventional dose of rosuvastatin calcium combined with ezetimibe in the treatment of carotid artery vulnerable plaque in patients with acute cerebral infarction of large-artery atherosclerosis subtype(LAA).Methods:184 patients with LAA in our department from January 2016 to February 2019 were selected.According to the random number table,they were divided equally into the control group and the observation group.The control group was given enhanced rosuvastatin calcium(20 mg/night),while the observation group was given conventional dose of rosuvastatin calcium(10 mg/night)combined with ezetimibe(10 mg/day)for 12 months.The number,volume,Crouse scores of atherosclerotic vulnerable plaques,serum CRP,IL-6,TNF-a and MMP-9 levels were measured in drug use before,drug use in 3,6 and 12 months.furthermore,the incidence of adverse reactions and dependence of patient at the end of the trial were evaluated.Results:There are not significant differences both observation group and control group compared the number of vulnerable plaques,total plaque volume and Crouse score in taking medicine 3 months with before taking medicine(P>0.05),those in taking medicine 6 and 12 months significantly decrease comparing with before taking medicine(P<0.05)in the two groups,it is lower in observation group than in the control group(6 months:P<0.05,12 months:P<0.01).Serum CRP,IL-6,TNF-a and MMP-9 levels in the two groups are lower in taking medicine 3,6 and 12 months than before taking medicine(P<0.05).Comparing observation group with control group,there are not significantly difference of the serum CRP,IL-6,TNF-a and MMP-9 levels in taking medicine 3 months(P>0.05),and significantly difference in taking medicine 6 and 12 months(6 months:P<0.05,12 months:P<0.01).At the end of trial,the incidence of abnormal liver function,elevated creatine kinase and muscle pain in the observation group was lower than that in the control group,with statistically significant difference(P<0.05),the incidence of diarrhea in the observation group was higher than that in the control group,with statistically significant difference(P<0.05).There are not significantly difference of the follow-up rate in taking medicine 3 and 6 months between observation group and control group(P>0.05),the follow-up rate of the observation group was significantly lower than that of the control group in taking medicine 12 months(P<0.05).The dropout rate in the observation group was significantly lower than that in the control group(P<0.05).Conclusions:The conventional dose of rosuvastatin calcium combined with ezetimibe in the treatment of carotid atherosclerotic vulnerable plaque in patients with LAA is better than enhanced rosuvastatin calcium,likewise low incidence of adverse reactions and good patient dependence exist?in the former,so it worth promoting in clinical.