丁苯酞下调血清脂蛋白相关磷脂酶A2改善急性大动脉粥样硬化型脑梗死患者预后的临床观察

The clinical observation of butylphthalide improves the prognosis of patients with acute large-artery atherosclerosis cerebral infarction by decreasing serum lipoprotein-related phospholipase A2

目的探讨丁苯酞能否通过调节急性大动脉粥样硬化型(LAA)脑梗死患者血清脂蛋白相关磷脂酶A2(Lp-PLA2)、颈动脉内膜中层厚度(IMT)而改善患者预后。方法选择急性LAA脑梗死患者60例,随机分为丁苯酞组及对照组,每组30例。丁苯酞组予静脉滴注丁苯酞注射液(100 mL/次,2次/日,连续14 d),序贯口服丁苯酞软胶囊(0.2 g/次,3次/日,连续11.5个月),对照组静脉滴注生理盐水(100 mL/次,2次/日,连续14 d)。所有患者均于治疗前及治疗12个月后检测血清Lp-PLA2水平;行颈部血管超声检测IMT并采用美国国立卫生研究院卒中量表(NIHSS)评估患者神经功能缺损情况。结果2组患者治疗后的Lp-PLA2水平比治疗前均有所下降,但丁苯酞组Lp-PLA2水平下降较对照组更为明显(P<0.01)。治疗12个月后,丁苯酞组患者IMT值低于对照组(P<0.05)。2组患者治疗后NIHSS评分均明显下降,但丁苯酞组下降更为显著(P<0.01)。结论丁苯酞治疗可以降低血清Lp-PLA2水平,进而缓解动脉粥样硬化进展,改善急性LAA脑梗死患者的预后。

Objective To explore whether butylphthalide can improve the prognosis of patients with acute large-artery atherosclerosis(LAA)cerebral infarction by regulating serum level of lipoprotein-related phospholipase A2(Lp-PLA2)and carotid intima-media thickness(IMT).Methods Sixty patients with acute LAA cerebral infarction were recruited and randomly divided into the two groups:the butylphthalide group and the control group,with 30 cases in each group.The butylphthalide group was intravenously injected with butylphthalide injection(100 mL/dose,2 times/day for 14 days)and received sequential oral butylphthalide soft capsule(0.2 g/dose,3 times/day for 11.5 months),while the control group was given intravenous drip of normal saline(100 mL/dose,2 times/day for 14 days).Serum levels of Lp-PLA2,IMT from cervical vascular ultrasound examination and neurological deficit score(NIHSS score)were measured before treatment and 12 months after treatment.Results The level of Lp-PLA2 in both groups decreased after treatment compared with before treatment(P<0.05),but the decrease was more obvious in the butylphthalide group than that in the control group(P<0.01).After 12 months of treatment,IMT was significantly lower in the butylphthalide group than that in the control group(P<0.05).NIHSS scores were significantly decreased after treatment in the two groups(P<0.05),but the decrease in the butylphthalide group was more significant(P<0.01).Conclusion Butylphthalide treatment can reduce the serum Lp-PLA2 level and alleviate the progression of atherosclerosis so that improve the prognosis of patients with acute LAA cerebral infarction.