目的：探讨普罗布考联合阿托伐他汀对急性脑梗死患者血清高敏C反应蛋白（high sensitivity C-re⁃active protein , hs-CRP）、氧化型低密度脂蛋白(oxidized low-density lipoproteins , ox-LDL)及基质金属蛋白酶-9(marix metalloproteinase-9, MMP-9)水平和颈动脉斑块的影响。方法选择196例急性脑梗死患者为研究对象，入院查颈动脉彩超提示存在动脉硬化斑块，随机分为两组，常规治疗组98例，予阿托伐他汀(20 mg/d)；联合治疗组98例，予阿托伐他汀(20 mg/d)、普罗布考(500 mg/d)联合治疗。两组患者分别于治疗前、治疗后1、6、12个月检测血清hs-CRP、ox-LDL及MMP-9水平和观察治疗前、治疗后12个月颈动脉内中膜厚度(IMT)、斑块面积及斑块数量变化。结果①与治疗前比较，两组治疗后1个月、6个月、12个月血清hs-CRP和MMP-9水平明显下降，差异有统计学意义（常规组：t=10.157,13.619,16.211和t=33.684,48.563,47.951，联合组：t=14.662,23.586,28.179和t=47.023,50.239,50.774，P均＜0.01），ox-LDL水平在联合治疗组治疗后1个月、6个月、12个月呈显著下降，差异有统计学意义（t=4.592,5.011,5.892，P均＜0.01），而在常规治疗组虽呈下降趋势，但差异无统计学意义（P＞0.05）。治疗后相同时间点比较，hs-CRP、ox-LDL和MMP-9水平联合治疗组低于常规治疗组，差异有统计学意义（t=7.655、5.271、2.492，t=4.927、3.772、4.673和t=16.862、4.251、2.045。P＜0.01或P＜0.05）。②治疗前，两组IMT值、斑块面积和斑块数量差异无统计学意义(P＞0.05)；治疗12个月后，与常规治疗组比，联合治疗组IMT值及斑块面积均下降，斑块数量减少，差异有统计学意义（t=6.117,3.290,2.158，P均＜0.05）。结论普罗布考联合阿托伐他汀可分别从降低hs-CRP、ox-LDL及MMP-9水平，具有更强的抗氧化、逆转和稳定斑块作用。%Objective To explore the influence of the combination therapy of probucol with atorvastatin on levels of serum high sensitivity C-reactive protein (hs-CRP), oxidized low-density lipoproteins (ox-LDL), and marix metallopro⁃ teinase-9 (MMP-9) and resolution of carotid plaque in patients with acute cerebral infarction (ACI). Methods One hun⁃ dred-six patients with acute cerebral infarction who had carotid artery color Doppler ultrasound-confirmed atherosclerot⁃ ic plaques , were included in the present study. The patients were randomly divided into two groups: conventional treat⁃ ment group ( 40 cases) which received atorvastatin (20mg/d) and co-treatment group (40 cases) which received Atorvas⁃ tatin (20mg/d) and Probucol (500mg/d). Levels of hs-CRP, ox-LDL and MMP-9 were detected in all patients before treat⁃ ment and 1, 6 and 12 months after drug therapy. The Intima-media thickness, area and numbers of carotid plaques were evaluated by using Doppler ultrasonography during a 12 months follow-up period. Results ① Serum hs-CRP and MMP-9 levels were significantly decreased at 1, 6 and 12 months after treatment, (conventional treatment group:t =14.662, 23.586, 28.179 and co-treatment group:t =47.023, 50.239, 50.774,P <0.01). The ox-LDL levels was obviously de⁃ creased in the combined treatment group (t =4.592, 5.011, 5.892,P <0.01) but not in conventional treatment group (P > 0.05) at 1, 6 and 12 months after treatment. Serum hs-CRP, ox-LDL and MMP-9 levels were significantly lower in com⁃ bined treatment group than in the conventional treatment group at all time points after treatment (t =7.655, 5.271, 2.492, t =4.927, 3.772, 4.673 andt =16.862, 4.251, 2.045.P <0.01 orP <0.05). ②There were not statistically differences in the IMT, plaque area and plaque numbers between these two groups before treatment (P >0.05). The IMT, plaque area and plaque numbers were significantly smaller in combined treatment group than in conventional treatment group (t =6.117, 3.290, 2.158,P <0.05). Conclusions The combination therapy of probucol with atorvastatin can greatly reduce levels of serunl hs-CRP,ox-LDL and MMP-9, indicating that the combination therapy has a strong anti-oxidant function, thereby reversing and stabilizing the atherosclerosis plaque.
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