阿托伐他汀对高血压脑出血患者脑水肿、神经功能及IL-33水平的影响

The Effect of Atorvastatin on Cerebral Edema,Neurological Function,and IL-33 Levels in Patients with Hypertensive Intracerebral Hemorrhage

目的探讨阿托伐他汀对高血压脑出血(hypertensive intracerebral hemorrhage,HCH)患者白介素-33(IL-33)水平的影响。方法80例HCH患者随机平分为对照组、观察组,对照组用常规方法治疗,观察组用常规方法联合口服阿托伐他汀治疗。疗程结束时对比两组总有效率、脑水肿绝对体积和相对体积、美国国立卫生院卒中量表(national institutes of health stroke scale,NIHSS)、格拉斯哥昏迷指数(glasgow coma index,GCS)评分,神经元特异性烯醇化酶(neuron specific enolase,NSE)、中枢神经特异蛋白(central nervous system specific protein,S100β)、白介素-33(interleukin-33,IL-33)、白介素-1β(interleukin-1β,IL-1β)、肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)和C反应蛋白(C-reactive protein,CRP)水平。结果治疗后,观察组总有效率95%高于对照组78%(χ^(2)=5.168,P<0.05)。治疗前两组脑水肿的绝对、相对体积接近,对比差异无统计学意义(t=0.181、0.797,P>0.05);治疗后两组脑水肿的绝对、相对体积均低于治疗前(t=15.323、15.034、24.425、13.038,P<0.05),治疗后观察组脑水肿的绝对、相对体积均少于对照组(t=3.171、13.265,P<0.05)。治疗前两组NIHSS、GCS评分对比差异无统计学意义(t=0.778、0.967,P>0.05);治疗后两组NIHSS评分低于治疗前,GCS评分高于治疗前(t=27.370、23.857、7.101、4.443,P<0.05);治疗后观察组NIHSS评分少于对照组,GCS评分高于对照组(t=7.247、2.713,P<0.05)。治疗前两组NSE、S100β水平对比无统计学差异(t=0.425、0.349,P>0.05);治疗后两组NSE、S100β水平低于治疗前(t=6.065、4.436、20.109、7.030,P<0.05);治疗后观察组NSE、S100β水平少于对照组(t=2.278、12.818,P<0.05)。治疗前两组IL-33、IL-1β、TNF-α和CRP水平对比无统计学差异(t=0.043、1.265、0.708、0.157,P>0.05);治疗后两组IL-33、IL-1β、TNF-α和CRP水平低于治疗前(t=5.120、2.119、11.610、4.207、8.378、3.604、7.552、5.420,P<0.05);治疗后观察组IL-33、IL-1β、TNF-α和CRP水平少于对照组(t=3.703、3.336、2.389、5.087,P<0.05)。两组不良反应发生率对比,差异无统计学意义(χ^(2)=0.312,P>0.05)。结论阿托伐他汀治疗HCH患者疗效显著,显著促进水肿的吸收,减缓功能缺损,缓解意识障碍,降低NSE、S100β炎症因子水平,提高IL-33水平。

Objective To investigate the effect of atorvastatin on interleukin-33(IL-33)levels in patients with hypertensive intracerebral hemorrhage(HCH).Methods 80 patients with HCH were randomly divided into a control group and an observation group.The control group was given routine treatment,while the observation group was given oral atorvastatin on the basis of routine treatment.At the end of treatment,the total effective rate,absolute and relative volume of cerebral edema,national institutes of health stroke scale(NIHSS),glasgow coma index(GCS)score neuron specific enolase(NSE),central nervous system specific protein(S100β),interleukin-33(IL-33),interleukin-1β(IL-1β),tumor necrosis factor-α(TNF-α),and C-reactive protein(CRP)levels were compared between the two groups.Results After treatment,the total effective rate of the observation group was 95%higher than that of the control group by 78%(χ^(2)=5.168,P<0.05).Before treatment,the absolute and relative volumes of brain edema in the two groups before treatment were similar,and there was no statistical difference between the two groups(t-value=0.181,0.797,P>0.05);after treatment,the absolute and relative volumes of brain edema in both groups were lower than those before treatment(t=15.323,15.034,24.425,13.038,P<0.05)and the absolute and relative volumes of brain edema in the observation group were lower than those in the control group(t=3.171,13.265,P<0.05).There was no statistically significant difference in NIHSS and GCS scores between the two groups before treatment(t=0.778,0.967,P>0.05);after treatment,the NIHSS scores of the two groups were lower than that before treatment,while the GCS scores were higher than that before treatment(t=27.370,23.857,7.101,4.443,P<0.05);after treatment,the NIHSS score of the observation group was lower than that of the control group,while the GCS score was higher than that of the control group(t=7.247,2.713,P<0.05).There were no significant differences in NSE and S100βlevels between the two groups before treatment(t=0.425,0.349,P>0.05);the levels of NSE and S100βin two groups after treatment were lower than before treatment(t=6.065,4.436,20.109,7.030,P<0.05);after treatment,the levels of NSE and S100βin observation group were lower than those in control group(t=2.278,12.818,P<0.05).There were no significant differences in IL-33,IL-1β,TNF-αand CRP levels between the two groups before treatment(t=0.043,1.265,0.708,0.157,P>0.05);the levels of IL-33,IL-1β,TNF-αand CRP in two groups after treatment were lower than those before treatment(t=5.120,2.119,11.610,4.207,8.378,3.604,7.552,5.420,P<0.05);after treatment,the levels of IL-33,IL-1β,TNF-αand CRP in observation group were lower than those in control group(t=3.703,3.336,2.389,5.087,P<0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(χ^(2)=0.312,P>0.05).Conclusion Atorvastatin had a significant therapeutic effect on HCH patients,significantly promoting the absorption of brain edema,slowing down neurological deficits,alleviating consciousness disorders,and reducing NSE and S100βinflammatory factor levels increase IL-33 levels.