补体激活3a受体检测评估大剂量阿托伐他汀联合双联抗血小板治疗急性脑梗死的效果研究

Study on detection of complement component 3a receptor 1(C3AR1)in evaluating the efficacy of high-dose atorvastatin combined with dual antiplatelet therapy in the treatment of acute cerebral infarction

目的观察补体激活3a受体(complement component 3a receptor 1,C3AR1)评估大剂量阿托伐他汀联合双联抗血小板治疗急性脑梗死(acute cerebral infarct,ACI)的疗效及预后的价值。方法选取医院收治的ACI患者60例作为观察组,同期医院健康体检人群60例作为对照组。观察组按随机方法分为常规剂量组和大剂量组,各30例。使用逆转录-聚合酶链反应(reverse transcription-polymerase chain reaction,RT-PCR)检测2组治疗前和治疗1周、2周、4周后血清C3AR1基因表达水平差异,并检测患者颈动脉斑块(或软斑)数量、颈动脉内膜中层厚度(intima-media thickness,IMT),同时评价其美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分、生活自理量表评分(Activity of Daily Living Scale,ADL)、改良Rankin量表评分(Modified Rankin Score,mRS)、超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)及血脂[胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol,HDL-C)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol,LDL-C)]水平,通过Pearson方法分析C3AR1与以上指标的相关性。结果观察组的C3AR1 mRNA相对表达量高于对照组(P<0.05);2组的颈动脉斑块(或软斑)数量、IMT、NIHSS评分、ADL评分、mRS评分、hs-CRP水平、TC、TG、HDL-C和LDL-C水平及C3AR1 mRNA相对表达量随着治疗时间的延长而下降,且大剂量组下降趋势均低于常规剂量组,IMT、TC、TG、LDL-C的组间·时点间交互作用差异无统计学意义(P>0.05),其余组间、时点间、组间·时点间交互作用差异均有统计学意义(P<0.05)。经双变量Pearson相关性分析结果显示,治疗前C3AR1 mRNA相对表达量与ACI患者的颈动脉斑块(或软斑)数量、IMT、NIHSS评分、ADL评分、mRS评分、hs-CRP水平、TC、TG、HDL-C和LDL-C水平无相关性(P>0.05);治疗1周、2周及4周时,C3AR1 mRNA相对表达量与ACI患者的颈动脉斑块(或软斑)数量、IMT、NIHSS评分、ADL评分、mRS评分、hs-CRP水平、TC、TG、HDL-C和LDL-C水平呈正相关(P<0.05)。结论C3AR1检测可用于评估大剂量阿托伐他汀联合双联抗血小板治疗ACI的疗效和预后。

Objective To observe the value of complement component 3a receptor(C3AR1)in evaluating the efficacy and prognosis of high-dose atorvastatin combined with dual antiplatelet therapy(DAPT)in the treatment of acute cerebral infarction(ACI).Methods In total,60 patients with ACI treated in the hospital were selected as the observation group,and 60 healthy people undergoing physical examination in the hospital during the same period were selected as the control group.The observation group was randomly divided into routine-dose group and high-dose group,with 30 cases in each group.Reverse transcription polymerase chain reaction(RT-PCR)was used to detect the difference of serum C3AR1 gene expression between the two groups before treatment and at 1,2 and 4 weeks after treatment.The number of carotid plaques(or soft plaques)and carotid intima-media thickness(IMT)of patients were measured.In the meantime,National Institute of Health Stroke Scale(NIHSS)score,score of Activity of Daily Living Scale(ADL),modified Rankin Scale score(mRS),hypersensitive C-reactive protein(hs-CRP)and blood lipids[total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C)]were evaluated.The correlation between C3AR1 and the above indexes was analyzed by Pearson method.Results The relative expression of C3AR1 mRNA in the observation group was higher than that in the control group(P<0.05).The number of carotid plaques(or soft plaques),IMT,NIHSS score,ADL score,mRS score,hs-CRP level,TC,TG,HDL-C and LDL-C levels and the relative expression of C3AR1 mRNA in both groups were decreased with the prolongation of treatment time,and the decrease was smaller in the high-dose group than in the routine-dose group;there was no significant difference in IMT,TC,TG and LDL-C between time-points and interaction between groups(P>0.05),and there were significant differences in other indicators between groups,time points and time points between groups(P<0.05).Results Bivariate Pearson correlation analysis showed that,the relative expression of C3AR1 mRNA before treatment was not correlated with the number of carotid plaques(or soft plaques),IMT,NIHSS score,ADL score,mRS score,hs-CRP level,TC,TG,HDL-C and LDL-C level in patients with ACI(P>0.05).At 1,2 and 4 weeks after treatment,the relative expression of C3AR1 mRNA was positively correlated with the number of carotid plaques(or soft plaques),IMT,NIHSS score,ADL score,mRS score,hs-CRP level,TC,TG,HDL-C and LDL-C level in patients with ACI(P<0.05).Conclusion The detection of C3AR1 can be used to evaluate the efficacy and prognosis of high-dose atorvastatin combined with dual antiplatelet therapy in the treatment of ACI.