瑞舒伐他汀联合依折麦布对脑梗死患者血脂、颈动脉粥样硬化斑块和hs-CRP影响的临床研究

发布时间：2018-01-20 12:10

本文关键词： 瑞舒伐他汀依折麦布脑梗死动脉粥样硬化血脂 hs-CRP　出处：《苏州大学》2014年硕士论文　论文类型：学位论文

【摘要】：研究目的越来越多的临床证据表明，高脂血症是引起冠状动脉粥样硬化性心脏病、脑血管疾病的主要致病危险因素。在本研究中，通过对可定、益适纯联合调脂与可定单药调脂效果及安全性的比较，探讨更适合于脑梗死患者卒中二级预防用药的调脂方案。研究对象及方法选择2012年6月1日至2013年6月30日在苏州大学附属第二医院神经内科住院的脑梗死患者，均伴有颈动脉粥样硬化斑块和高脂血症（TC5.69mmol/L，LDL-C3.10mmol/L），，其中男性61例，女性37例；年龄48-71岁，平均61.32±7.36岁。所有患者入组前均未应用他汀类与盐酸类降脂药物治疗，均无肝肾功能异常，无急重症感染、3个月内无手术和外伤史，无代谢与内分泌系统疾病，无恶性肿瘤病史，预计生存期均超过1年，2组患者的性别、年龄等一般临床资料比较差异无统计学意义（P0.05），具有一致性。所有研究对象入院后均给予常规药物治疗，包括给予抗血小板聚集、降血压(脑梗死急性期除外)类药物，将所有入组的98例患者采用随机数字法分为对照组（n=49）和观察组（n=49）：对照组口服瑞舒伐他汀（品名可定，国药准字J20090091，阿斯利康制药有限公司）10mg，1次/d，观察组口服瑞舒伐他汀10mg+依折麦布（品名益适纯，进口药品注册证号:H20080132，美国先灵葆雅制药有限公司）10mg，1次/d，随访24周，分别在12周、24周于门诊抽空腹血监测血脂四项血清总胆固醇(TC)、甘油三酯（TG）、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇（HDL-C）、载脂蛋白B（Apo-B）、超敏C反应蛋白（hs-CRP）、肝功能（谷丙转氨酶ALT、谷草转氨酶AST）、肌酸激酶（CK）值，并于24周在心超室行颈动脉多普勒超声检查，测量颈总动脉内粥样斑块横切面的最大面积（Smax），于距颈总动脉分叉处1.0cm内测量颈动脉内膜中层厚度(IMT)，记录用药后主要终点事件（死亡）及次要终点事件（新发脑卒中）。结果2组治疗后TC、TG、LDL-C和Apo-B水平均较治疗前显著减低（P＜0.05），观察组LDL-C、TC和Apo-B的减低幅度明显低于对照组（P＜0.05）。治疗后观察组颈动脉粥样斑块最大面积较治疗前明显减小（P＜0.05），对照组治疗前、治疗后颈动脉粥样斑块面积无明显变化（P＞0.05）。2组治疗后hs-CRP水平均明显减低（P＜0.05），观察组与对照组比较无统计学差异（P＞0.05）。2组不良反应发生率比较差异无统计学意义（P＞0.05）。结论1.可定10mg或可定10mg+益适纯10mg都能显著降低血脂水平，但可定联合益适纯可更有效降低LDL-C和TC。 2.联合治疗对颈动脉粥样硬化斑块可能有一定的逆转作用。 3.高TC、LDL-C水平对颈动脉斑块的形成可能有一定的促进作用。 4.观察组与对照组相比较，不良反应发生率比较差异无统计学意义（P＞0.05）。
[Abstract]:Objective to study more and more clinical evidence that hyperlipidemia is the main risk factor for coronary atherosclerotic heart disease and cerebrovascular disease. To compare the efficacy and safety of Yishichun combined with orderable drugs in regulating lipid, and to explore a more suitable scheme for secondary prevention of stroke in patients with cerebral infarction. Participants and methods patients with cerebral infarction were selected from June 1st 2012 to June 30th 2013 in Department of Neurology, second affiliated Hospital of Suzhou University. All patients were accompanied with carotid atherosclerotic plaque and hyperlipidemia TC5.69 mmol / L LDL-C3.10 mmol / L, including 61 males and 37 females; The average age was 61.32 卤7.36 years old. All patients were not treated with statin or hydrochloric acid lipid-lowering drugs before entering the group. There was no abnormal liver and kidney function and no acute severe infection. There was no history of surgery and trauma, no metabolic and endocrine diseases, and no history of malignant tumor within 3 months. There was no significant difference in age and other general clinical data (P 0.05). All the subjects were given routine drug treatment, including anti-platelet aggregation. Drugs for lowering blood pressure (except acute cerebral infarction). All 98 patients in the group were randomly divided into two groups: control group (n = 98) and observation group (n = 49). The control group was treated by oral administration of rosuvastatin (product name can be determined, Chinese medicine accurate character J20090091). AstraZeneca Pharmaceutical Co., Ltd. 10mg / d, the observation group oral Risuvastatin 10mg Ezeimex (product name, import drug registration certificate no.: H20080132). The patients were followed up for 24 weeks and 12 weeks to 24 weeks, respectively, to monitor the blood lipid levels of four serum total cholesterol (TCs) in the abdominal blood of the outpatients. Triglyceride (TGN), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), apolipoprotein (Apo-Bn). Hypersensitive C-reactive protein (hs-CRP), liver function (alt, AST, CK), and carotid Doppler ultrasound were performed at 24 weeks. The maximum area of atherosclerotic plaques in the common carotid artery was measured and IMT was measured within 1.0 cm from the common carotid artery bifurcation. The main endpoint events (death) and secondary endpoint events (new stroke) were recorded. Results the levels of LDL-C and Apo-B were significantly lower in the two groups than before treatment (P < 0.05). The LDL-C in the observation group was significantly lower than that in the control group (P < 0.05). The decrease of TC and Apo-B was significantly lower than that of control group (P < 0.05). After treatment, the maximum area of carotid atherosclerotic plaque in observation group was significantly lower than that before treatment (P < 0.05), and before treatment in control group. After treatment, the area of carotid atherosclerotic plaque did not change significantly (P > 0.05). The level of hs-CRP decreased significantly after treatment (P < 0.05). There was no statistical difference between the observation group and the control group (P > 0.05). There was no significant difference in the incidence of adverse reactions between the observation group and the control group (P > 0.05). Conclusion 1. Both 10 mg and 10 mg of codeine can significantly reduce the level of blood lipid, but the combination of Kedalin and Isochon can effectively reduce LDL-C and TCC. 2. 2. Combined therapy may have a reversal effect on carotid atherosclerotic plaque. 3. High level of TCU LDL-C may promote carotid plaque formation. 4. There was no significant difference in the incidence of adverse reactions between the observation group and the control group (P > 0.05).
【学位授予单位】：苏州大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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