【作者】 刘丹；

【导师】 陶定波；

【作者基本信息】 大连医科大学 ， 神经内科学， 2009， 硕士

【摘要】 目的:缺血性脑血管病是临床常见病和多发病,是严重危害人类的健康的主要疾病之一,颈动脉粥样硬化是动脉粥样硬化性脑梗死的主要原因。在动脉粥样硬化的发生和发展过程中,动脉内膜是最早累及的地方。颈内动脉内中膜厚度(intima-media thickness, IMT)增厚是动脉粥样硬化的早期征象。阿托伐他汀钙是一种疗效确切的调脂药物,但其能否影响缺血性脑血管病患者颈动脉内膜厚度的相关研究不多。本研究对调查患者给予阿托伐他汀钙治疗,以探讨阿托伐他汀钙对颈动脉IMT、血脂及C-反应蛋白(C-reactive protein, CRP)及对心脑血管不良事件发生率影响。方法:随机选择我院门诊及住院的缺血性脑血管病患者150例,并被检出颈动内膜增厚,合并(或不合并)血脂升高,均符合强化降脂治疗标准的,并将患者统一编号随机分入A组(n=50)、B组(n=50)、C组(n=50)。A组为维持治疗组(阿托伐他汀20mg日一次连续治疗12个月),B组为中断治疗组(阿托伐他汀20mg日一次未达3个月),C组为对照组(未应用阿托伐他汀治疗)。最终完成104例患者为研究对象,并根据门诊或在住院或电话咨询方式进行随访,所选患者依据病情需要正规应用降血压、降血糖及抗血小板等药物,均未应用其他类降血脂药物,并在初诊、第1个月、3个月、6个月、12个月动态监测3组患者的血脂及CRP水平,并在第12个月进行颈动脉超声检查,评估颈动脉内膜中层厚度。观察治疗前后颈内动脉内中膜厚度(IMT)、总胆固醇(total cholesterol, TC)、甘油三酯(triglyceride, TG)、低密度脂蛋白胆固醇(low-density lipoprotein cholesterol, LDL-C)和高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)及C反应蛋白CRP的变化。结果:(1).A组患者在第12个月复诊时与初诊时颈内动脉内中膜厚度IMT比较有所降低,差异有统计学意义(P<0.05)。B组患者在第12个月复诊时与初诊时颈内动脉内中膜厚度IMT比较未见明显变化,差异无统计学意义(P>0.05)。C组患者在第12个月复诊时颈内动脉内中膜厚度IMT增加,与初诊比较差异无统计学意义(P>0.05)。(2).A组患者在治疗第1、3、6、12个月复诊时血脂检测TC、TG、LDL-C水平下降,HDL-C水平升高,与初诊时比较差异均有统计学意义(P<0.05),但A组患者在第1、3、6、12个月时组间血脂水平比较未见明显差异(P>0.05)。B组患者在第1、3个月复诊时血脂检测TC、TG、LDL-C水平下降,HDL-C水平升高,与初诊时比较差异均有统计学意义(P<0.05),在第12个月复诊时血脂检测TC、TG、LDL-C水平回升,HDL-C水平降低,与初诊时比较差异均无统计学意义(P>0.05)。C组患者在第12个月复诊时LDL、TG、TC水平升高,HDL-C水平降低,与治疗前比较有明显差异(P<0.05)。(3).阿托伐他汀应用1个月A组.B组CRP水平均明显下降。(4).服用阿托伐他汀应用12个月可以明显降低心脑血管事件发生率,未见严重不良反应.结论:(1).阿托伐他汀应用1个月可以明显降低血脂及CRP水平。(2).阿托伐他汀连续应用12个月可以降低颈内动脉内中膜厚度。(3).阿托伐他汀连续应用12个月降低心脑血管事件发生率。更多还原

【Abstract】 Objective: ischemic cerebrovascular disease is the common disease and frequently occurring illness in clinic. The carotid artery atherosclerosis is the main reason of cerebral infarction. Endarterium is the earliest involved in the process which happening and development of the athero- sclerosis. The thickening of intima-media thickness (IMT) in the carotid artery is the sign of earlier period of the atherosclerosis. Artorvastatin has the exact curative effect in the decreased blood lipid. The correlated study on the effect s of artorvastatin on atherosclerotic in patients with ischemic cerebrovascular disease is seldom. Giving artorvastatin to the patients is to explore the effect of artorvastatin on IMT, blood lipid, C-reactive protein (CRP), and the incidence rate of cardia-cerebral vessels disease.Method: A total of 150 patients with ischemic cerebrovascular disease, thickening of carotid IMT, hyperlipemia or not were randomly chosen in our clinic service and being in hospital. All of the patients who were in lined with the standard of intensive therapy were divided into group A, group B and group C randomly after coding according to unified number. Group A named maintenance therapy group, maintenance therapy group were given Atorvastatin of 20mg every night 12 months. Group B named breaking off therapy group were given Atorvastatin of 20mg every night less than 3 months. Group C named control group were not given Atorvastatin. Ulti- mately 104 patients as the subjects who were received follow-up in the way of clinic service or hospital or telephone consulation. All the patients are treated with controlling blood pressure, controlling blood sugar and a low dosage of aspirin to anti-platelet aggregation. The fasting serum lipid level and CRP level were measured at the beginning of the study and 1, 3, 6, 12 month after treatment in three groups. In addition to IMT was measured by ultrasound at the beginning of the study and 12 month. To observe the diversify of artorvastatin on triglyceride(TG), total cholesterol(TC), low- density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol (HDL-C),C-reactive protein CRP and IMT.Results: (1). IMT decreased in A group at 12 month and it was different from the beginning of the study (P<0.05). The changing of The IMT was not obvious in group B at 12 month (P>0.05). The IMT increased in group C at 12 month and it was different from the beginning of the study (P<0.05); (2).The level of serum TC, TG and LDL-C dropped obviously and HDL-C rose up in1,3,6,12 month in group A (P<0.05). The level of serum lipid in interclass was not obviously different at 1, 3, 6, 12 month in group A. The level of serum TC, TG and LDL-C dropped obviously and HDL-C rose up in1,3, mo- nth in group B(P<0.05). But the level of serum TC, TG and LDL-C ascended and HDL-C descended at 12 month in group .The level of serum TC, TG and LDL-C rose up and HDL-C dropped in12 month in group C (P<0.05). (3). Atorvastatin could obviously be able to cut down the level of CRP at 1 month in group A and group B. (4) It could obviously be able to cut down the incidence of cardia-cerebral vessels and had no serious ad- verse reaction.Conclusion: (1). Atorvastatin treatment could obviously lower the level of serum lipid and CRP after application one month. (2). Atorvastatin treat- ment could lower IMT after continuous application 12 months. (3). Atorvas- tatin treatment could lower the incidence of cardia-cerebral ves- sels.更多还原