不同剂量阿托伐他汀钙片在缺血性脑血管疾病患者脑血管介入治疗中应用效果的对比研究

摘要

Objective To compare the application effect in ischemic cerebrovascular disease patients treated by cerebrovascular interventional therapy between low-dose and high-dose atorvastatin calcium tablets.Methods From 2015 to 2016,a total of 126 patients with ischemic cerebrovascular disease were selected in the Department of Neurology,the 92ed Hospital of the Chinese People's Liberation Army,all of them received cerebrovascular interventional therapy,and they were divided into control group and study group according to random number table,each of 63 cases.Patients of control group received low-dose atorvastatin calcium tablets (20 mg) before 3 days of using contrast medium and after cerebrovascular interventional therapy,while patients of study group received high-dose atorvastatin calcium tablets (80 mg) before 3 days of using contrast medium and high-dose of atorvastatin calcium tablets (40 mg) after cerebrovascular interventional therapy.Blood lipids index (including TC,TG,HDL-C and LDL-C) and index of liver function (including AST and ALT) before 24 hours of operation and after 72 hours of operation,index of renal function (including Scr,BUN,Ccr,β2-MG and Cys-C) and hs-CRP before operation,after 24 hours and 72 hours of operation were compared between the two groups;both groups treated for 4 weeks,incidence of adverse reactions and contrast-induced nephropathy was observed during the treatment.Results No statistically significant differences of TC,TG,HDL-C,LDL-C,AST or ALT was found between the two groups before 24 hours of operation or after 72 hours operation (P ＞0.05).There was interaction between time and method in Scr,BUN,Ccr,~-MG,Cys-C and hs-CRP (P ＜0.05);main effect of method was significant in Scr,BUN,Ccr,β2-MG,Cys-C and hs-CRP (P ＜0.05);main effect of time was significant in Scr (P ＜ 0.05),was not significant in BUN,Ccr,β2-MG,Cys-C or hs-CRP (P ＞ 0.05);after 24 and 72 hours of operation,Scr,BUN,ββ2-MG,Cys-C and hs-CRP of study group were statistically significantly lower than those of control group,while Ccr of study group was statistically significantly higher than that of control group,respectively (P ＜ 0.05).No one of the two groups occurred any serious adverse reactions or contrast-induced nephropathy during the treatment.Conclusion Both low-dose and high-dose atorvastatin calcium tablets can effectively prevent the incidence of contrast-induced nephropathy in ischemic cerebrovascular disease patients treated by cerebrovascular interventional therapy,but high-dose atorvastatin calcium tablets can more effectively improve the renal function with relatively high safety.%目的 比较不同剂量阿托伐他汀钙片在缺血性脑血管疾病患者脑血管介入治疗中的应用效果.方法 选取2015-2016年于中国人民解放军第九二医院神经内科行脑血管介入治疗的缺血性脑血管疾病患者126例,采用随机数字表法分为对照组与研究组,每组63例.对照组患者于使用造影剂前3d及脑血管介入治疗后睡前顿服阿托伐他汀钙片20 mg;研究组患者于使用造影剂前3d睡前顿服阿托伐他汀钙片80 mg,脑血管介入治疗后睡前顿服阿托伐他汀钙片40 mg.比较两组患者术前24h和术后72 h血脂指标[总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]及肝功能指标[天冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)],术前及术后24h、72 h肾功能指标[血肌酐(Scr)、尿素氮(BUN)、内生肌酐清除率(Ccr)、β2微球蛋白(β2-MG)、胱抑素C(Cys-C)]和超敏C反应蛋白(hs-CRP)水平;两组患者均治疗4周,观察治疗期间不良反应及对比剂肾病(CIN)发生情况.结果 手术前后两组患者TC、TG、HDL-C、LDL-C、AST、ALT水平比较,差异无统计学意义(P＞0.05).时间与方法在Scr、BUN、Ccr、β2-MG、Cys-C、hs-CRP上存在交互作用(P＜0.05);方法在Scr、BUN、Ccr、β2-MG、Cys-C、hs-CRP上主效应显著(P＜0.05);时间在Scr上主效应显著(P＜0.05),时间在BUN、Ccr、β2-MG、Cys-C、hs-CRP上主效应不显著(P＞0.05);术后24h、72 h研究组患者Scr、BUN、β2-MG、Cys-C、hs-CRP低于对照组,Ccr高于对照组(P＜0.05).两组患者治疗期间均未发生严重不良反应及CIN.结论 小剂量与大剂量阿托伐他汀钙片均可有效预防缺血性脑血管疾病患者脑血管介入治疗后CIN的发生,而大剂量阿托伐他汀钙片可更有效地改善患者肾功能,且安全性较高.