强化降脂对缺血性脑卒中患者的血脂、炎症因子的影响及安全性研究

发布时间：2018-05-18 05:42

本文选题：急性缺血性脑卒中 + 他汀强化降脂治疗　；参考：《广西医科大学》2016年硕士论文

【摘要】：目的缺血性脑卒中(Ischemic Stroke,IS)发病率、死亡率及致残率高,预后差,是一种严重危害人类健康和生命的常见病。阿托伐他汀由于多效性作用,主要用于预防和治疗心脑血管疾病,而国人卒中患者早期强化降脂治疗后,血脂达标率和安全性的研究数据较少。本次研究主要评价IS/TIA患者行短期强化降脂治疗的临床疗效,为临床用药及安全性提供科学依据。方法收集2015年6月至2015年12月我院收治的符合纳入标准的首发AIS/TIA患者80例,随机分为20mg阿托伐他汀常规剂量治疗组28例(A组)、40mg阿托伐他汀治疗组27例(B组)和60mg治疗组25例(C组)。所有患者在缺血性脑血管病的常规治疗基础上予不同剂量阿托伐他汀,期间不服用其他调脂类药物,观察并比较3组患者治疗前和治疗12天后、3个月后的血脂(包括：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)、超敏C反应蛋白(hs-CRP)、基质金属蛋白酶-9(MMP-9)的变化。同时检测患者的肝功能及肌酶等不良反应,ALT/CK升高达正常值上限3/5倍则停药观察。记录住院及随访期间病例情况。采用SPSS17.0统计软件对所有临床资料和实验数据进行处理,计量资料以X±S表示,组间比较采用方差分析、组内比较采用配对t检验对数据进行统计分析和显著性检验,以P0.05表示差异有统计学意义。结果1、所有患者临床基线水平较一致。2、阿托伐他汀治疗12天后,三组TC、TG、LDL-C水平较基线值均降低,差异具有统计学意义；用药3个月后,三组LDL-C水平分别降至2.03 ±0.46mmol/L、1.71±0.37mmol/L、1.57±0.44mmol/L,较基线水平分别降幅25.09%、36.43%、44.52%,组间差异具有统计学意义。3、用药3个月后,MMP-9和hs-CRP降幅C组最强,A组最弱。4、3组治疗前后转氨酶、肌酶变化差异均无统计学意义,3组均无脑出血发生。结论阿托伐他汀强化降脂、抗炎作用依赖于他汀剂量,强化组60mg优于40mg组,且短期使用安全性良好。
[Abstract]:Objective the incidence, mortality and disability rate of ischemic stroke are high, and the prognosis is poor. It is a common disease that seriously endangers human health and life. Atto vastatin is mainly used in the prevention and treatment of cardiovascular and cerebrovascular diseases because of its pleiotropic effect. However, there is little data on the rate of blood lipids reaching the standard and the safety of Chinese stroke patients after early intensive lipid-lowering therapy. The purpose of this study was to evaluate the clinical efficacy of short-term intensive lipid lowering in patients with IS/TIA and to provide scientific evidence for clinical use and safety. Methods from June 2015 to December 2015, 80 patients with first-episode AIS/TIA who were admitted to our hospital from June 2015 to December 2015 were collected. They were randomly divided into two groups: group A (n = 28) treated with 20mg Atto vastatin (n = 28) and group B (n = 27) treated with 40 mg Atto vastatin (n = 27) and group C (n = 25) treated with 60mg. All patients were given different doses of Atto vastatin on the basis of routine treatment of ischemic cerebrovascular disease, and no other lipid-regulating drugs were taken during the period. Observe and compare the serum lipids (including total cholesterol TC, triglyceride TG, low density lipoprotein cholesterol LDL-C, high density lipoprotein cholesterol HDL-CU, hypersensitive C-reactive protein hs-CRPU, matrix gold) in 3 groups before and after 12 days of treatment. The change of MMP-9 is a kind of protease. At the same time, liver function and muscle enzyme were detected and alt / CK increased to the upper limit of normal value by 3 / 5 times. The cases were recorded during hospitalization and follow-up. All the clinical data and experimental data were processed by SPSS17.0 software. The measurement data were expressed as X 卤S, the analysis of variance was used in the inter-group comparison, and the statistical analysis and significance test were performed by paired t test in the intra-group comparison. The difference was statistically significant with P0.05. Results 1. The clinical baseline level was the same in all patients. After 12 days of treatment with Atto vastatin, the LDL-C levels of TCG in the three groups were all lower than the baseline values, and the difference was statistically significant after 3 months of treatment. The LDL-C level of the three groups decreased to 2.03 卤0.46 mmol / L 1.71 卤0.37 mmol / L respectively, which was 25.09 卤0.44 mmol / L, 25.09 and 36.43 mm / L, respectively. The difference between the three groups was statistically significant. After 3 months of treatment, the levels of MMP-9 and hs-CRP in group C were the weakest and the weakest in group A before and after treatment. There was no significant difference in the changes of muscle enzymes between the three groups. Conclusion the antiinflammatory effect of Atto vastatin is dependent on the dosage of statins. The 60mg of the fortified group is better than that of the 40mg group, and the short-term use safety is good.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R743.3

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