摘要
目的:分析脑梗死患者阿托伐他汀干预前后脑内代谢物N-乙酰天门氨酸、肌酸、胆碱复合物等变化,观察不同疗程阿托伐他汀的降脂效果及其对预后的影响。方法:选择2004-04/2005-06大连医科大学附属第二医院住院的发病5d内的脑梗死患者58例,将其随机分为3组:①对照组(n=20):采用科室制定的脑梗死标准治疗方案穴包括阿司匹林,维生素E,C,红花注射液雪加安慰剂治疗。②阿托伐他汀30,90d组(n=19):采用标准治疗方案加阿托伐他汀10mg/d,其中30d组阿托伐他汀治疗30d后停药加安慰剂至90d,90d组阿托伐他汀治疗90d停药。分别在急性期(发病5d内)、发病3个月时进行质子磁共振波谱观察病变核心区N-乙酰天门氨酸/肌酸和胆碱复合物/肌酸及病变核心区与对称区域N-乙酰天门氨酸、胆碱复合物、肌酸比值变化;应用美国国立卫生研究院卒中量表(评分0(正常)～35分)及Barthel指数(满分100分,<60分为不能自理)评估其神经功能缺损程度和日常生活活动能力;检测血清总胆固醇、三酰甘油和高、低密度脂蛋白胆固醇水平。结果:58例患者全部进入结果分析。①质子磁共振波谱结果:各组患者发病3个月时与急性期比较胆碱复合物/肌酸3组均增高(P<0.05),阿托伐他汀90d组增高更明显,且组间有差异(P<0.05);N-乙酰天门氨酸/肌酸对照组降低,阿托伐他汀两组增高,但组间无差异。②发病3个月时3组美国国立卫生研究院卒中量表得分均降低、Barthel指数增高穴P<0.05雪,但组间无差异。③发病3个月时胆固醇和低密度脂蛋白胆固醇浓度对照组增高穴P<0.05),阿托伐他汀30,90d组降低,后者降低更明显穴P<0.05),且与前两组比较差异显著穴P<0.05)。④阿托伐他汀两组治疗期间除5例患者有恶心、腹泻外均能耐受。结论:脑梗死后应用阿托伐他汀穴10mg/d雪30d可达到降脂效果,用药时间长,效果明显且安全;未发现其降脂或降脂外明显的脑保护作用,对脑梗死患者的预后无改善。
AIM： To analyze changes of N-acetylaspartate （Naa）, creatine （Cr） and choline （Cho）, etc. in brain of patients with cerebral infarction before and after being intervened by atorvastatin, and observe the effect of atorvastatin on lowering lipid and prognosis of patients with acute cerebral infarction.
METHODS： A total of 58 patients with cerebral infarction, who were hospitalized within 5 days after onset of illness at the Second Clinical Hospital Affiliated to Dalian Medical University between April 2004 and June 2005, were enrolled and divided into three groups randomly： ① control group （n =20）： Standard treatment prescription for cerebral infarction designed by division （composed of aspirin, vitamin E and C, safflower solution） combined with placebo was applied. ②Atorvastatin 30, 90 days group （n=19）： Standard treatment prescription combined with 10 mg atorvastatin per day was used. The patients in the 30 day group were treated with placebo till the 90^th day after being treated with atorvastatin for 30 days. Those in the 90 days group were treated with atorvastain for 90 days. The changes of Naa/Cr and Cho/Cr in lesion＇s core and antimere of lesion＇s core respectively were observed in acute period （within 5 days after onset of illness） and 3 months after episode with proton magnetic resonance spectroscopy （PMRS）. Degree of neurologic impairment and ability of activities of daily living （ADL） were evaluated with the National Institute of Health Stroke Scale （NIHSS） （0 as normal - 35 points） and Bartbel Index （BI） （full mark was 100 points; 〈 60 indicated unable selfcare）. Levels of serum total cholesterol, triacylglycerol, high and low density lipoprotein cholesterols were detected.
RESULTS： Totally 58 patients were involved in the final analysis, ① Result of PMRS： The Cho/Cr increased at the 3^rd month after onset as compared with the acute period in each group （P 〈 0.05）. It was more significant in .the atorvastatin 90 days group, and there was difference among groups （P 〈 0.05）. Naa/Cr decreased in the control group, while it increased in the atorvastatin groups, but there was no difference among groups. ②Scores of NIHSS decreased, while thescores of BI increased at the 3^nl month after episode in the 3 groups （P〈 0.05）, but there was no difference among groups. ③Concentrations of the cholesterol and low density lipeprotein cholesterol increased in the control group at the 3^rd month after onset of illness （P 〈 0.05）. It decreased in the atorvastatin 30, 90 days groups, and the latter decreased extremely obviously （P 〈 0.05）, and the difference was marked as compared with the former two groups （P 〈 0.05）. ④The patients in the atorvastatin groups could bear except 5 patients with nausea or diarrhea.
CONCLUSION： Atorvastatin （10 mg per day） for 30 days after cerebral infarction can lower blood lipid. The longer the drug is applied, the more significant the effect is, what-should be mentioned is to use atorvastatin is safe; obvious cerebral protective effect related to atorvastatin was not found, and the atorvastatin has no amelioration on the prognosis of cerebral infarction patients.
出处
《中国临床康复》
CSCD
北大核心
2006年第20期28-31,i0001,共5页
Chinese Journal of Clinical Rehabilitation
基金
国家自然科学基金项目(30470682)
2005年度辽宁省优秀青年科研人才培养资金资助项目(305006)
辽宁省重点实验室专项资金计划项目(37)~~
