阿托伐他汀强化降脂对急性脑梗死血清炎症介质水平的影响及疗效

摘要

目的：探讨阿托伐他汀强化降脂对急性脑梗死血清炎症介质水平的影响及疗效。方法选取2011年7月~2013年10月慈溪市人民医院收治的急性脑梗死患者76例,将其随机分为强化组和常规组。两组入院后均予以控制颅内压、调整血压和血糖、抗血小板聚集、营养脑细胞等基础治疗。常规组加用阿托伐他汀钙片20 mg,1次/d,口服；强化组加用阿托伐他汀片40 mg,1次/d,两组疗程均为4周。观察两组治疗前后血清超敏C反应蛋白(hs-CRP)、白介素-18(IL-18)和基质金属蛋白酶-9(MMP-9)水平的变化,并比较其临床疗效。结果治疗4周后,强化组和常规组血清hs-CRP、IL-18和MMP-9[(5.12±1.02)mg/L、(70.26±18.75)pg/mL、(169.34±41.32)μg/L,(7.68±1.84)mg/L、(98.69±21.54)pg/mL、(235.17±56.24)μg/L]均较治疗前[(10.04±2.75)mg/L、(118.76±31.27)pg/mL、(297.85±64.21)μg/L,(9.95±2.41)mg/L、(120.34±29.82)pg/mL、(301.02±59.27)μg/L]显著下降(t =2.34、2.18、2.28、3.29、2.89、2.99,P<0.05或P<0.01),且强化组下降幅度明显大于常规组(t=2.40、2.30、2.29,P<0.05)；强化组临床总有效率明显高于常规组(94.74%比78.95%)(字2=4.15,P<0.05)。结论阿托伐他汀强化降脂治疗急性脑梗死效果确切,能明显改善患者的神经功能缺损程度,其作用与其能降低血清hs-CRP、IL-18和MMP-9水平密切相关。%Objective To discuss influence and curative effect of intensive lipid lowering with Atorvastatin on serum inflammatory mediator levels of acute cerebral infarction. Methods 76 cases of patients with acute cerebral infarction, who were given the medical treatment in Cixi People's Hospital from July 2011 to October 2013 were selected and di-vided into strengthened group and routine group at random. The patients in two groups were given basic medical treat-ment such like control of intracranial pressure (ICP), adjustment of blood pressure and blood sugar, anti-platelet aggre-gation, nutrition of brain cells and etc.. The patients in routine group were additionally given 20 mg Atorvastatin Calci-um Tablets once a day through the mouth for 4 weeks, while the patients in strengthened group were additionally given 40 mg Atorvastatin Tablets once a day for 4 weeks. The changes of serum hs-CRP, IL-18 and MMP-9 levels of pa-tients in two groups before and after treatment were observed, and clinical curative effect was compared as well. Re-sults After 4 weeks' medical treatment, the serum hs-CRP, IL-18 and MMP-9 levels of patients in strengthened group and routine group [(5.12±1.02) mg/L, (70.26±18.75) pg/mL, (169.34±41.32)μg/L;(7.68±1.84) mg/L, (98.69±21.54) pg/mL, (235.17±56.24) μg/L] were all decreased significantly compared with before treatment [(10.04±2.75) mg/L, (118.76±31.27) pg/mL, (297.85±64.21) μg/L; (9.95±2.41) mg/L, (120.34±29.82) pg/mL, (301.02±59.27) μg/L] (t = 2.34, 2.18, 2.28, 3.29, 2.89, 2.99,P< 0.05 or P< 0.01), and the declining rate of patient in strengthened group was much higher than that in routine group (t = 2.40, 2.30, 2.29,P< 0.05). Meanwhile, total clinical efficiency of patients in strength-ened group was much higher than that in routine group (94.74% vs 78.95%) (χ²=4.15, P<0.05). Conclusion Intensive lipid lowering with Atorvastatin has a reliable curative effect on acute cerebral infarction and can obviously improve the nerve function damage degree, whose mechanism of action has close effect on reducing serum hs-CRP, IL-18 and MMP-9 levels.