瑞舒伐他汀钙联合普罗布考对缺血性脑血管病患者脂蛋白磷脂酶A2、超敏C反应蛋白和斑块易损性的影响
发布时间：2018-08-05 17:24
【摘要】：目的脑血管病发生、发展的过程中,脂蛋白相关性磷脂酶A2(Lp-PLA2)、超敏C-反应蛋白(hs-CRP)及动脉粥样硬化不稳定斑块起着尤为重要的作用。临床上,将瑞舒伐他汀及普罗布考联合应用,可能产生协同的抗氧化、抗炎、抗动脉粥样硬化、改善血管内皮功能、稳定和逆转斑块的作用,从而减少脑梗死的发生和复发。本课题通过给予存在颈动脉粥样硬化斑块的患者联合应用瑞舒伐他汀及普罗布考治疗,研究其治疗前后外周血中的脂蛋白相关性磷脂酶A2(Lp-PLA2)、超敏C-反应蛋白(hs-CRP)水平的变化及颈动脉超声形态学、颈动脉内-中膜厚度、斑块数量和斑块超声回声特征的变化,探讨联合应用瑞舒伐他汀及普罗布考干预治疗对脂蛋白相关性磷脂酶A2(Lp-PLA2)、超敏C-反应蛋白(hs-CRP)及颈动脉粥样硬化斑块易损性的影响。方法随机选取在2013年4月至2014年1月于本院神经内科住院的首次发生缺血性脑卒中并且经颈部血管彩超证实存在ACS的患者100例,其中男性62例,女性38例,年龄在50-80岁,所选上述病例均符合WHO建议的ACS的诊断标准。所选病例无脑血管病病史,并且排除中途因其他原因死亡,感染性疾病、癌症、心衰、糖尿病、肝肾功能衰竭病例。对于所选病例随机单盲分为2组,分别为:对照组和治疗组,两组病例各50例,对照组:男性27例,女性23例,年龄52-78岁,平均年龄61.3±3.2岁;治疗组:男性35例,女性15例,年龄在50-80岁,平均年龄63.2±2.3岁。两组(治疗组、对照组)之间在年龄、性别、体重指数、吸烟例数、高血压例数、左室射血分数、血压、心率、血脂水平的差异上均无统计学意义(P0.05)。两组入院次日均空腹抽取6ml静脉血,测定外周血脂蛋白相关性磷脂酶A2(Lp-PLA2)、超敏C-反应蛋白(hs-CRP)水平,并均行颈部血管彩超检查了解颈动脉形态、颈动脉内-中膜厚度、斑块数量和斑块回声特征。对照组给予饮食治疗,改善生活方式,且48h内应用瑞舒伐他汀(IPR Pharmaceuticals,INC.生产,商品名可定,规格10mg/片)10mg睡前一次。治疗组除上述措施外,另外加服普罗布考(承德颈复康药业集团生产,商品名畅泰,规格0.25g/片)0.5g早晚餐时各一次。经临床治疗6个月后复查,观察两组治疗前后及两组治疗后外周血脂蛋白相关性磷脂酶A2(Lp-PLA2)、超敏C-反应蛋白(hs-CRP)的水平变化,及颈动脉形态、颈动脉内-中膜厚度、斑块数量和斑块回声特征的变化。脂蛋白相关性磷脂酶A2(Lp-PLA2)以散射比浊法测定,由南京诺尔曼生物技术有限公司提供试剂盒,由我院生化室的全自动生化分析仪来进行数据的测定。超敏C-反应蛋白(hs-CRP)以免疫投射比浊法测定,由天津九鼎生物工程有限公司提供试剂盒,由我院生化室的全自动生化分析仪来进行数据的测定。颈部血管彩超应用HDI-3500彩色多普勒超声仪全程检测颈总动脉及颈内动脉的颅外段,观察颈动脉有无狭窄及狭窄程度、内膜厚度及斑块情况。常用的检测指标包括:颈动脉IMT测定、颈动脉粥样硬化斑块积分、斑块面积、斑块情况(包括斑块大小、斑块形态、斑块回声特征。结果对照组及治疗组治疗前外周血脂蛋白相关性磷脂酶A2(Lp-PLA2)、超敏C-反应蛋白(hs-CRP)的水平及颈动脉内-中膜厚度(CIMT)、斑块面积、斑块数量、易损斑块数目比较差异无显著性(P0.5)。对照组及治疗组治疗前后比较外周血脂蛋白相关性磷脂酶A2(Lp-PLA2)、超敏C-反应蛋白(hs-CRP)的水平及颈动脉内-中膜厚度(CIMT)、斑块面积、斑块数量、易损斑块数目均有下降,差异有统计学意义(P0.05)。说明单用瑞舒伐他汀与联合应用瑞舒伐他汀及普罗布考均能降低外周血Lp-PLA2、hs-CRP水平,并能减少CIMT、斑块面积、斑块数量、低回声斑块数量。而试验又表明:两组经治疗后,治疗组比对照组对外周血超敏C-反应蛋白水平、CIMT、斑块面积、斑块数量、低回声斑块数量的降低幅度更大,差异有统计学意义(P0.05),并且治疗后治疗组比对照组对外周血脂蛋白相关性磷脂酶A2(Lp-PLA2)水平的降低幅度更为显著,差异有显著性(P0.01)。说明联合应用瑞舒伐他汀及普罗布考在降低外周血脂蛋白相关性磷脂酶A2(Lp-PLA2)、超敏C-反应蛋白(hs-CRP)水平、减少颈动脉内-中膜厚度(CIMT)、斑块面积、斑块数量、易损斑块数目方面优于单用瑞舒伐他汀。结论瑞舒伐他汀联合普罗布考,不但可以调脂、抗氧化,还具有抗炎作用,可有效减低血Lp-PLA2、hs-CRP、延缓动脉粥样硬化及斑块形成。
[Abstract]:Objective in the course of the development of cerebrovascular disease, lipoprotein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) and atherosclerotic unstable plaques play an important role. The combination of rosuvastatin and probucol may produce synergistic antioxidation, anti-inflammatory, anti atherosclerosis, and improvement. Vascular endothelial function, stabilizing and reversing the role of plaque, thus reducing the occurrence and recurrence of cerebral infarction. In this study, the lipoprotein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (H) in the peripheral blood of the patients with carotid atherosclerotic plaques were treated with the combined use of rosuvastatin and probucol. S-CRP) changes in level and carotid artery ultrasound morphology, carotid artery and middle membrane thickness, plaque quantity and changes in ultrasonic echo characteristics of plaque, and explore the effects of combined use of rosuvastatin and probucol on lipoprotein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) and vulnerability of carotid atherosclerotic plaques Methods a random selection of 100 patients with ACS in the neurology department of our hospital from April 2013 to January 2014 was selected and confirmed by cervical vascular color Doppler ultrasound. There were 62 males, 38 females, 38 women and 50-80 years old. The selected cases were all in accordance with the diagnostic criteria of ACS recommended by WHO. The history of disease, and the exclusion of other causes of death, infectious diseases, cancer, heart failure, diabetes, liver and kidney failure cases. The selected cases were randomly divided into 2 groups, the control group and the treatment group, 50 cases in the two groups and the control group, 27 males, 23 women, 52-78 years old, and the average age of 61.3 + 3.2 years; the treatment group: Male 35 cases, 15 women, age 50-80, the average age of 63.2 + 2.3 years. The two groups (treatment group, control group) between age, sex, body mass index, smoking cases, the number of hypertension, the left ventricular ejection fraction, blood pressure, heart rate, blood lipid level were not statistically significant (P0.05). The two group the next day the abdominal extraction of 6ml venous blood, determine the peripheral blood Blood lipid protein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) level, and cervical artery color Doppler ultrasound examination to understand the morphology of the carotid artery, the thickness of the carotid artery and middle membrane, the number of plaque and the echo characteristics of the plaque. The control group was given diet therapy to improve the lifestyle, and 48h was used in IPR Pharmaceuticals, INC. birth. Production, commodity name can be fixed, specification 10mg/ tablet) 10mg before bedtime. In addition to the above measures, the treatment group plus probucol (Chengde jufukang Pharmaceutical Group production, commodity name Chang Tai, 0.25g/ tablets) 0.5g breakfast each time. After 6 months of clinical treatment reexamination, observe the relationship between the two groups after treatment and two groups of peripheral blood lipid protein correlation The changes in the level of phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP), the morphology of the carotid artery, the thickness of the internal carotid artery and middle membrane, the number of plaque and the echo characteristics of the plaque. The lipoprotein related phospholipase A2 (Lp-PLA2) was determined by the scattering Turbidimetry. The kits were provided by the Nanjing Norman Biotechnology Co., Ltd. and the whole biochemical laboratory in our hospital. The automatic biochemical analyzer is used to determine the data. The hypersensitive C- reaction protein (hs-CRP) is determined by turbidimetry with immuno projection. The data is measured by the automatic biochemical analyzer of the biochemical laboratory in our hospital by Tianjin Jiuding Bioengineering Co., Ltd. and the whole course detection of the HDI-3500 color Doppler ultrasound apparatus for cervical vascular color super application. The extracranial segment of the common carotid artery and the internal carotid artery, the degree of stenosis and stenosis of the carotid artery, the thickness of the intima and the plaque condition. The common indicators included carotid IMT, plaque score, plaque area, and plaque condition (including plaque size, plaque shape, and plaque echo characteristics. Results control and treatment group treatment) The level of phospholipase A2 (Lp-PLA2), the level of hypersensitive C- reactive protein (hs-CRP) and the thickness of the internal carotid artery and middle membrane (CIMT), the area of plaque, the number of plaque and the number of vulnerable plaques were not significantly different (P0.5). In the control group and the treatment group, the peripheral blood lipid protein related phospholipase A2 (Lp-PLA2) and hypersensitivity C- were compared in the control group and the treatment group. The level of hs-CRP and the thickness of the carotid artery and middle membrane (CIMT), the area of plaque, the number of plaque and the number of vulnerable plaques decreased, and the difference was statistically significant (P0.05). It indicated that the single use of rosuvastatin and combined use of rosuvastatin and probucol could reduce the level of Lp-PLA2 and hs-CRP in peripheral blood and reduce the size of CIMT, plaque area, and plaque. The number of blocks and hypoechoic plaques in the two groups showed that after treatment, the level of CIMT, patch area, plaque quantity and low echo plaques in the two groups were significantly lower than those in the control group, and the difference was statistically significant (P0.05), and the treatment group was related to the peripheral blood lipid protein in the treatment group. The level of sex phospholipase A2 (Lp-PLA2) decreased significantly (P0.01), indicating that the combined use of rosuvastatin and probucol in reducing peripheral blood lipid protein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) level, reducing the thickness of the carotid artery and middle membrane (CIMT), plaque area, plaque quantity, vulnerable plaque The number is better than rosuvastatin alone. Conclusion rosuvastatin combined with probucol not only can regulate lipid, antioxidant, but also have anti-inflammatory effects, which can effectively reduce blood Lp-PLA2, hs-CRP, delay atherosclerosis and plaque formation.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743
本文编号：2166473
[Abstract]:Objective in the course of the development of cerebrovascular disease, lipoprotein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) and atherosclerotic unstable plaques play an important role. The combination of rosuvastatin and probucol may produce synergistic antioxidation, anti-inflammatory, anti atherosclerosis, and improvement. Vascular endothelial function, stabilizing and reversing the role of plaque, thus reducing the occurrence and recurrence of cerebral infarction. In this study, the lipoprotein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (H) in the peripheral blood of the patients with carotid atherosclerotic plaques were treated with the combined use of rosuvastatin and probucol. S-CRP) changes in level and carotid artery ultrasound morphology, carotid artery and middle membrane thickness, plaque quantity and changes in ultrasonic echo characteristics of plaque, and explore the effects of combined use of rosuvastatin and probucol on lipoprotein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) and vulnerability of carotid atherosclerotic plaques Methods a random selection of 100 patients with ACS in the neurology department of our hospital from April 2013 to January 2014 was selected and confirmed by cervical vascular color Doppler ultrasound. There were 62 males, 38 females, 38 women and 50-80 years old. The selected cases were all in accordance with the diagnostic criteria of ACS recommended by WHO. The history of disease, and the exclusion of other causes of death, infectious diseases, cancer, heart failure, diabetes, liver and kidney failure cases. The selected cases were randomly divided into 2 groups, the control group and the treatment group, 50 cases in the two groups and the control group, 27 males, 23 women, 52-78 years old, and the average age of 61.3 + 3.2 years; the treatment group: Male 35 cases, 15 women, age 50-80, the average age of 63.2 + 2.3 years. The two groups (treatment group, control group) between age, sex, body mass index, smoking cases, the number of hypertension, the left ventricular ejection fraction, blood pressure, heart rate, blood lipid level were not statistically significant (P0.05). The two group the next day the abdominal extraction of 6ml venous blood, determine the peripheral blood Blood lipid protein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) level, and cervical artery color Doppler ultrasound examination to understand the morphology of the carotid artery, the thickness of the carotid artery and middle membrane, the number of plaque and the echo characteristics of the plaque. The control group was given diet therapy to improve the lifestyle, and 48h was used in IPR Pharmaceuticals, INC. birth. Production, commodity name can be fixed, specification 10mg/ tablet) 10mg before bedtime. In addition to the above measures, the treatment group plus probucol (Chengde jufukang Pharmaceutical Group production, commodity name Chang Tai, 0.25g/ tablets) 0.5g breakfast each time. After 6 months of clinical treatment reexamination, observe the relationship between the two groups after treatment and two groups of peripheral blood lipid protein correlation The changes in the level of phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP), the morphology of the carotid artery, the thickness of the internal carotid artery and middle membrane, the number of plaque and the echo characteristics of the plaque. The lipoprotein related phospholipase A2 (Lp-PLA2) was determined by the scattering Turbidimetry. The kits were provided by the Nanjing Norman Biotechnology Co., Ltd. and the whole biochemical laboratory in our hospital. The automatic biochemical analyzer is used to determine the data. The hypersensitive C- reaction protein (hs-CRP) is determined by turbidimetry with immuno projection. The data is measured by the automatic biochemical analyzer of the biochemical laboratory in our hospital by Tianjin Jiuding Bioengineering Co., Ltd. and the whole course detection of the HDI-3500 color Doppler ultrasound apparatus for cervical vascular color super application. The extracranial segment of the common carotid artery and the internal carotid artery, the degree of stenosis and stenosis of the carotid artery, the thickness of the intima and the plaque condition. The common indicators included carotid IMT, plaque score, plaque area, and plaque condition (including plaque size, plaque shape, and plaque echo characteristics. Results control and treatment group treatment) The level of phospholipase A2 (Lp-PLA2), the level of hypersensitive C- reactive protein (hs-CRP) and the thickness of the internal carotid artery and middle membrane (CIMT), the area of plaque, the number of plaque and the number of vulnerable plaques were not significantly different (P0.5). In the control group and the treatment group, the peripheral blood lipid protein related phospholipase A2 (Lp-PLA2) and hypersensitivity C- were compared in the control group and the treatment group. The level of hs-CRP and the thickness of the carotid artery and middle membrane (CIMT), the area of plaque, the number of plaque and the number of vulnerable plaques decreased, and the difference was statistically significant (P0.05). It indicated that the single use of rosuvastatin and combined use of rosuvastatin and probucol could reduce the level of Lp-PLA2 and hs-CRP in peripheral blood and reduce the size of CIMT, plaque area, and plaque. The number of blocks and hypoechoic plaques in the two groups showed that after treatment, the level of CIMT, patch area, plaque quantity and low echo plaques in the two groups were significantly lower than those in the control group, and the difference was statistically significant (P0.05), and the treatment group was related to the peripheral blood lipid protein in the treatment group. The level of sex phospholipase A2 (Lp-PLA2) decreased significantly (P0.01), indicating that the combined use of rosuvastatin and probucol in reducing peripheral blood lipid protein related phospholipase A2 (Lp-PLA2), hypersensitive C- reactive protein (hs-CRP) level, reducing the thickness of the carotid artery and middle membrane (CIMT), plaque area, plaque quantity, vulnerable plaque The number is better than rosuvastatin alone. Conclusion rosuvastatin combined with probucol not only can regulate lipid, antioxidant, but also have anti-inflammatory effects, which can effectively reduce blood Lp-PLA2, hs-CRP, delay atherosclerosis and plaque formation.
【学位授予单位】：泰山医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743
【参考文献】
相关期刊论文 前1条
1 谭泽梁;蓝崧;杨职;;阿托伐他汀钙对急性脑梗死患者血清C-反应蛋白水平和脑梗死复发的影响[J];中国实用神经疾病杂志;2010年04期
，本文编号：2166473
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