普罗布考治疗颈动脉易损斑块的临床研究

发布时间：2018-09-01 19:40

【摘要】：目的比较实验组和对照组治疗前后颈动脉易损斑块检出率和颈动脉内膜中层厚度,以及治疗期间缺血性卒中事件的发生率,从而评价普罗布考治疗颈动脉易损斑块的临床效果。方法入选对象为我院2012年10月至2013年6月住院和门诊患者100例,均经彩色超声检查明确存在颈动脉易损粥样斑块。入选排除标准：排除肿瘤、肝脏病变、感染性疾病,近期无重大外伤、手术史。100例患者(其中男性79例,女性21例,年龄41岁～75岁)随机分为试验组(n=50)和对照组(n=50)。两组患者基础治疗基本相同,均口服阿司匹林肠溶片100mg,每日1次(拜耳医药保健有限公司),阿托伐他汀钙片20mg,每日1次(辉瑞制药有限公司),入选对象根据病情需要予抗高血压药、降血糖药等治疗。试验组在常规治疗基础上加服普罗布考250mg,2次/日(山东齐鲁制药有限公司,每片125mg)；服药治疗6个月。治疗期间不服用同类或其他调脂药物及抗氧化剂等对动脉粥样硬化有影响的药物。观察治疗前及治疗后3个月和6个月后实验组和对照组患者原有斑块的厚度变化和颈动脉易损斑块检出率以及治疗过程中两组缺血性卒中的发病率。用药前后及组间比较用配对t检验,计数资料比较用x2检验。P0.05为差异有统计学意义。实验结果两组患者治疗前颈动脉易损斑块检出率一致,均为100%；颈动脉内膜中层厚度治疗前比较,差异无统计学意义(P0.05)。治疗3个月后：实验组颈动脉易损斑块检出率由治疗前100%降至42%,对照组颈动脉易损斑块检出率由治疗前100%降至62%。实验组的颈动脉易损斑块转为稳定斑块的病例明显高于对照组。X2=4.00,P0.05,有统计学差异。实验组颈动脉易损斑块IMT治疗前为3.34±0.42mm,治疗后为2.07±0.38mm,对照组颈动脉易损斑块IMT治疗前3.15±0.50mm,治疗后为2.41±0.32mm。治疗后两组对比P0.05,有统计学差异。治疗6个月后：实验组颈动脉易损斑块检出率由治疗前100%降至6%,对照组颈动脉易损斑块检出率由治疗前100%降至20%。实验组的颈动脉易损斑块转为稳定斑块的病例明显高于对照组。X2=4.33,P0.05,有统计学差异。两组患者颈动脉IMT比较,实验组颈动脉易损斑块IMT治疗前为3.3.4±0.42mm,治疗后为1.29±0.51mm,对照组颈动脉易损斑块IMT治疗前3.15±0.50mm,治疗后为1.63±0.37mmm。治疗前两组对比P0.05,无统计学差异；治疗后两组对比P0.05,有统计学差异。结论本试验证实了普罗布考可抑制氧化应激,从源头阻断动脉粥样硬化的发生,稳定易损斑块,并减小斑块体积,抑制斑块进展,阻止斑块的破裂及事件的发生。在易损斑块的治疗中,抗血小板治疗和他汀类药物治疗作用值得肯定。
[Abstract]:Objective to evaluate the clinical efficacy of probucol in the treatment of carotid artery vulnerable plaque by comparing the detection rate of carotid artery vulnerable plaque, carotid intima-media thickness and the incidence of ischemic stroke events between experimental group and control group before and after treatment. Methods from October 2012 to June 2013, 100 inpatients and outpatients were enrolled in our hospital. The presence of carotid atherosclerotic plaques was confirmed by color ultrasound. Exclusion criteria: exclusion of tumors, liver lesions, infectious diseases, no recent major trauma, and surgical history of 100 patients (male 79, female 21, age 41 to 75) were randomly divided into the trial group (n = 50) and the control group (n = 50). The basic treatment of the two groups was basically the same. All patients were treated with 100 mg aspirin enteric-coated tablets once a day (Bayer Medical Care Co., Ltd), Atto vastatin calcium tablets 20 mg and once a day (Pfizer Pharmaceutical Co., Ltd.). The subjects were given antihypertensive drugs and hypoglycemic drugs according to their condition. The experimental group was given probucol 250 mg / d (Shandong Qilu Pharmaceutical Co., Ltd, each tablet 125mg) on the basis of routine treatment, and treated with probucol for 6 months. Do not take the same or other lipid-regulating drugs and antioxidants that have an effect on atherosclerosis during treatment. The changes of plaque thickness and the detection rate of carotid vulnerable plaque were observed before treatment, 3 months and 6 months after treatment, and the incidence of ischemic stroke in the two groups during the treatment. Before and after the use of drugs and the comparison between groups with paired t test, count data comparison using x2 test. P0.05 as the difference was statistically significant. The results showed that the detection rate of carotid vulnerable plaque was the same in the two groups before treatment, which was 100%. There was no significant difference in carotid intima-media thickness before treatment (P0.05). After 3 months of treatment, the detection rate of vulnerable plaque in carotid artery decreased from 100% to 42% in the experimental group and from 100% to 62% in the control group. The cases with stable plaque of carotid artery in the experimental group were significantly higher than those in the control group (P 0.05). The IMT of vulnerable plaque in experimental group was 3.34 卤0.42mm before treatment and 2.07 卤0.38mm after treatment. In control group, IMT was 3.15 卤0.50mm before treatment and 2.41 卤0.32mm. After treatment, there was a statistical difference between the two groups (P 0.05). After 6 months of treatment, the detection rate of vulnerable plaque in carotid artery decreased from 100% to 6% in the experimental group and from 100% to 20% in the control group. The cases with stable plaque in the carotid artery in the experimental group were significantly higher than those in the control group (P 0.05). IMT of carotid artery was 3.3.4 卤0.42mm before treatment and 1.29 卤0.51mm after treatment in experimental group, and 3.15 卤0.50mm before IMT treatment and 1.63 卤0.37mm after treatment in control group. There was no statistical difference between the two groups before treatment, and there was statistical difference between the two groups after treatment. Conclusion Probucol can inhibit oxidative stress, block atherosclerosis from the source, stabilize vulnerable plaque, reduce plaque volume, inhibit plaque progression, and prevent plaque rupture and events. In the treatment of vulnerable plaque, anti-platelet therapy and statins are worthy of recognition.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

【参考文献】