【作者】 张强；

【导师】 薛茜；

【作者基本信息】 河北北方学院 ， 神经病学（专业学位）， 2018， 硕士

【摘要】 第一部分hs-CRP、ox-LDL与颈动脉斑块易损性的关系目的:研究脑梗死患者血清hs-CRP、ox-LDL与颈动脉斑块易损性有密切关系,以作为药物治疗效果的生物学指标。方法:收集2017年7月至2017年9月在河北北方学院附属第一医院住院的脑梗死患者110例,均进行颈动脉彩超检查,并诊断存在颈动脉斑块。根据斑块的超声学特征将患者分成稳定斑块组与易损斑块组。测定所有患者的血清ox-LDL、hs-CRP,分析ox-LDL、hs-CRP与斑块易损性的相关关系,比较组间ox-LDL、hs-CRP的水平。结果:110例脑梗死患者中易损斑块患者60例(54.55%),稳定斑块患者50例(45.45%)。ox-LDL与斑块易损性存在相关性(r=0.863,P<0.001),hs-CRP与斑块易损性存在相关性(r=0.863,P<0.001)。稳定斑块组ox-LDL、hs-CRP分别为(21.18±1.48)U﹒m L-1,(0.45±0.13)mg﹒L-1,易损斑块组的ox-LDL、hs-CRP分别为(38.80±1.85)U﹒m L-1,(1.06±0.12)mg﹒L-1。易损斑块组的ox-LDL、hs-CRP均明显高于稳定斑块组(P<0.05)。结论:血清hs-CRP、ox-LDL与颈动脉斑块的易损性存在紧密关系。第二部分对比单用阿托伐他汀与联合普罗布考治疗对颈动脉易损斑块的疗效目的:证明阿托伐他汀与普罗布考联合治疗更能明显地降低ox-LDL、hs-CRP、Lp-PLA2水平,较单用阿托伐他汀更能促进斑块稳定,为脑梗死的防治提供新方法。方法:选取第一部分研究中易损斑块组的患者60例,其中男31例,女29例。将其随机分成阿托伐他汀单药治疗组(A组)30例,男18例,女12例,平均年龄66.10±3.79岁。阿托伐他汀+普罗布考治疗组(A+P组)30例,男13例,女17例,平均年龄66.47±3.32岁,分别给予药物治疗3个月后,再次测定血清ox-LDL、hs-CRP、Lp-PLA2,测量IMT。结果:单药治疗组治疗前血清ox-LDL、hs-CRP、Lp-PLA2的测定值分别为(38.73±2.05)U﹒m L-1,(1.07±0.11)mg﹒L-1,(202.11±10.06)RU﹒m L-1,治疗3个月后分别为(36.78±1.51)U﹒m L-1,(0.86±0.14)mg﹒L-1,(167.91±5.70)RU﹒m L-1。A+P组治疗前分别为(38.87±1.67)U﹒m L-1,(1.05±0.12)mg﹒L-1,(202.66±9.08)RU﹒m L-1,治疗3个月后分别为(31.93±1.25)U﹒m L-1,(0.67±0.13)mg﹒L-1,(150.00±7.08)RU﹒m L-1。两组ox-LDL、hs-CRP、Lp-PLA2水平均减少(P<0.05),A+P组减少更明显(P<0.05)。结论:联合应用普罗布考较单用阿托伐他汀能更有效地降低ox-LDL、hs-CRP、Lp-PLA2水平,更能促进斑块稳定,对CAS的治疗效果更佳。更多还原

【Abstract】 Part 1 the relation between hs-CRP、ox-LDL and the vulnerability of carotid artery plaque in cerebral infarction patiensObjective: To study the relation between serum hs-CRP、ox-LDL level and the vulnerability of carotid artery plaque in cerebral infarction patients.Methods: select 110 cerebral infarction patients who were be hospitalized from July2017 to september2017 in affiliated hospital of Hebei north university.all patients were measured by carotid artery ultrasound,and were made a definite diagnosis with carotid artery plaque.all ischemic stroke patients were split into vulnerable plaque group(n=60)and stable plaque(n=50)according to their carotid ultrasonographic findings.The levels of ox-LDL,hs-CRP were detected and the intima media thickness of plaque were measured.Analysis the relation of the levels of serum ox-LDL,hs-CRP in atherosclerosis cerebral infarction patients between the different plaques.Results: There are 60 vulnerable plaque patients(54.55%),50 stable plaque patients(45.45%)in the all cerebral infarction patients,The serum ox-LDL levels of vulnerable plaque group(38.80±1.85 U ﹒ m L-1)was significantly higher than the serum ox-LDL levels of stable plaque group(21.18±1.48 U ﹒ m L-1)(P<0.05);The serum hs-CRP levels of vulnerable plaque group(1.06±0.12 mg﹒L-1)was higher than the serum hs-CRP levels of stable plaque group(0.45±0.13mg﹒L-1)(P<0.05).serum ox-LDL is closely related with the vulnerability of plaque(r=0.863,P<0.001),hs-CRP is closely related with the vulnerability of plaque(r=0.863,P<0.001).Conclusions: The levels of serum ox-LDL,hs-CRP in cerebral infarction patients are closely related with the vulnerability of plaque.Part 2 Compare the Effects of Atorvastatin Monotherapy And Combined with Probucol on Carotid Vulnerable Plaque of Cerebral Infarction PatientsObjective: To prove the effects of probucol combined with atorvastatin is better than the effects of atorvastatin monotherapy on carotid vulnerable plaque of cerebral infarction patients.Methods: select 60 cerebral infarction patiens with vulnerable plaque of Part 1,which include 31 males and 29 females,all patiens were divided randomly into two groups:atorvastatin group(group A)were treated with atorvastatin(20mg/d,qn)which include 18 males and 12 females,whose average age were 66.10±3.79 years;combined treatment group(group A+P)were treated with atorvastatin(20mg/d,qn)combined with probucol(0.25 g,bid),which included 13 males and 17 females,whose average age were 66.47±3.32 years.The levels of oxidized low density lipoprotein(ox-LDL),high sensitive c-reactive protein(hs-CRP),Lipoprotein-associated Phospholipase A2(Lp-PLA2)and the carotid artery plaque were detected after 3 months treatment.Results: before treatment,the levels of ox-LDL,hs-CRP,Lp-PLA2 in the group A were(38.73±2.05)U ﹒ m L-1,(1.07±0.11)mg.L-1,(202.11±10.06)RU﹒m L-1 respectively,The levels of ox-LDL,hs-CRP,Lp-PLA2 in the group A+P were(38.87±1.67)U﹒m L-1,(1.05±0.12)mg﹒L-1,(202.66±9.08)RU﹒m L-1,there were no significant difference between the two groups before treatment,after 3 months treatment,The levels of ox-LDL,hs-CRP,Lp-PLA2 in the group A were(36.78±1.51)U﹒m L-1,(0.86±0.14)mg.L-1,(167.91±5.70)RU﹒m L-1 respectively,The levels of ox-LDL,hs-CRP,Lp-PLA2 in the group A+P were(31.93±1.25)U﹒m L-1,(0.67±0.13)mg﹒L-1,(150.00±7.08)RU﹒m L-1 respectively,all serum indexes of two groups reduce significantly than pre-treatment(P<0.05),The levels of serum ox-LDL,hs-CRP,Lp-PLA2 in group A+P decrease remarkably than group A(P<0.05).there were obvious difference between two groups.Conclusions: Probucol combined with atorvastatin could degrade the level of Lp-PLA2,inhibit the formation of ox-LDL and anti-inflammation.It’s effect is better than the effects of atorvastatin monotherapy on carotid atherosclerosis of cerebral infarction patients.It is a significant strategy to stabilize plaques for treatment of cerebral infarction with vulnerable plaque.It will be a better treatment to antiatherosclerosis in the secondary prevention of cerebral infarction.更多还原